- •Knowing the phases of wound healing and their typical progression are crucial in surveillance of progression and treating wounds with appropriate management strategies.
- •Multiple patient and wound-related factors can complicate wound healing. If these factors are not considered, delays in healing may turn an uncomplicated wound into a chronic nonhealing wound.
- •Negative pressure wound therapy improves wound healing by 5 known mechanisms and can be used by multiple different techniques for open and closed wounds.
- •New treatments under investigation include fish skin application, photobiomodulation, and bioelectric dressings. Treatments such as low-level laser therapy, hyperbaric oxygen therapy, stem cell, and platelet-rich plasma injections continue to be studied with mixed results.
Veterinary Clinics of North America: Small Animal Practice
《北美獸醫臨床：小動物診療》
Volume 52, Issue 2, March 2022, Pages 289-315
第 52 卷第 2 期，2022 年 3 月，第 289-315 頁
第 52 卷第 2 期，2022 年 3 月，第 289-315 頁
Updates in Wound Management and Dressings
傷口管理與敷料的最新進展
Full text access 全文存取
Keywords 關鍵字
Wound healing
Wound management
Topical wound treatments
Fish skin dressing
Bioelectric dressing
Leeches
Regenerative medicine wound treatments
Bandaging
傷口癒合｜傷口管理｜局部傷口治療｜魚皮敷料｜生物電敷料｜水蛭療法｜再生醫學傷口治療｜包紮技術
Key points 重點摘要
Background 背景
Introduction 引言
Wound management is an ever-changing field in veterinary medicine with the advent of new cellular treatments and new topical dressings occurring all the time. The care of patients with wounds is performed by veterinarians of all experience levels and across the world with each locale enduring unique challenges. There are differences in wound healing depending on causation, comorbidities, and species that must always be taken into account and owners' finances and availability of care also play significant roles in management decisions. To choose the most beneficial treatment, a thorough understanding of the phases of wound healing is a necessity as each treatment is specifically tailored to benefit certain phases.
傷口管理是獸醫學中不斷變化的領域，隨著新的細胞治療和新型局部敷料的不斷出現。傷患照護由不同經驗水平的獸醫師在全球各地執行，每個地區都面臨獨特的挑戰。傷口癒合會因病因、共病症和物種而有所差異，這些都必須納入考量，而飼主的財務狀況和照護資源的可及性也在管理決策中扮演重要角色。要選擇最有益的治療方式，必須徹底了解傷口癒合的階段，因為每種治療都是針對特定癒合階段量身訂做的。
While this chapter will not discuss the initial management of wounds (clipping, cleaning, flushing, debridement, and so forth), it will provide a brief review of the phases of wound healing, specific anatomic and patient considerations, and species differences. The majority of the chapter will then focus on innovative treatment modalities and dressings and when best to use them.
雖然本章不會討論傷口的初期處理（剃毛、清潔、沖洗、清創等），但將簡要回顧傷口癒合階段、特定解剖結構與病患考量因素，以及物種差異。本章大部分內容將聚焦於創新治療方式和敷料，以及最佳使用時機。
傷口管理是獸醫學中不斷變化的領域，隨著新的細胞治療和新型局部敷料的不斷出現。傷患照護由不同經驗水平的獸醫師在全球各地執行，每個地區都面臨獨特的挑戰。傷口癒合會因病因、共病症和物種而有所差異，這些都必須納入考量，而飼主的財務狀況和照護資源的可及性也在管理決策中扮演重要角色。要選擇最有益的治療方式，必須徹底了解傷口癒合的階段，因為每種治療都是針對特定癒合階段量身訂做的。
While this chapter will not discuss the initial management of wounds (clipping, cleaning, flushing, debridement, and so forth), it will provide a brief review of the phases of wound healing, specific anatomic and patient considerations, and species differences. The majority of the chapter will then focus on innovative treatment modalities and dressings and when best to use them.
雖然本章不會討論傷口的初期處理（剃毛、清潔、沖洗、清創等），但將簡要回顧傷口癒合階段、特定解剖結構與病患考量因素，以及物種差異。本章大部分內容將聚焦於創新治療方式和敷料，以及最佳使用時機。
Basic principles of wound healing
傷口癒合的基本原則
The phases of wound healing are a continuum with overlapping phases commonly occurring (Table 1). It is also important to note that within one wound there may be areas undergoing different phases at the same time. An exhaustive discussion of the phases can be found in other references1, 2, 3, 4 but a brief synopsis follows.
傷口癒合的階段是一個連續的過程，各階段常會重疊發生（表 1）。同樣重要的是需注意，同一個傷口內可能同時存在不同區域正處於不同癒合階段。關於各階段的詳細討論可參考其他文獻 1,2,3,4，以下簡要概述：
傷口癒合的階段是一個連續的過程，各階段常會重疊發生（表 1）。同樣重要的是需注意，同一個傷口內可能同時存在不同區域正處於不同癒合階段。關於各階段的詳細討論可參考其他文獻 1,2,3,4，以下簡要概述：
Table 1. Phases of healing and the cell types involved
表 1. 癒合階段及參與的細胞類型
| Phase 階段 | Cell Type 細胞類型 | Action 作用 |
|---|---|---|
| Inflammatory phase 發炎期 | Injured endothelial cells 受傷的內皮細胞 | release of catecholamines → vasoconstriction →vasodilation 兒茶酚胺釋放 → 血管收縮 → 血管擴張 |
| Injured endothelial cells 受傷的內皮細胞 | release thromboplastin to initiate extrinsic clotting cascade 釋放凝血活酶以啟動外在凝血途徑 | |
| Activated platelets 活化的血小板 | cytokine & growth factor release→ migration of white blood cells into the wound 細胞激素與生長因子釋放→白血細胞遷移至傷口處 | |
| Debridement phase 清創階段 | Neutrophils 中性粒細胞 | degeneration releases enzymes and free radicals that kill bacteria and break down debris 變性釋放酶和自由基以殺死細菌並分解殘骸 |
| Monocytes/Macrophages 單核細胞/巨噬細胞 | synthesize and secrete growth factors for tissue formation 合成並分泌生長因子以促進組織形成 | |
| Stimulate angiogenesis and matrix production 刺激血管新生與基質生成 | ||
| Repair/Proliferation phase 修復/增生階段 | ||
| Fibroplasia 纖維組織形成 | Fibroblasts 纖維母細胞 | migrate into fibrin clot and proliferate 遷移至纖維蛋白凝塊並增生 |
| Collagen and elastin synthesis 膠原蛋白與彈性蛋白合成 | ||
| Macrophages 巨噬細胞 | stimulate migration of fibroblasts 刺激纖維母細胞遷移 | |
| Angiogenesis 血管新生 | Existing vascular endothelial cells 現有的血管內皮細胞 | migrate into wound behind fibroblasts giving tissue red color ∗granulation tissue = new capillaries, fibroblasts, fibrous tissue & extracellular matrix 跟隨纖維母細胞遷移至傷口處，使組織呈現紅色 ∗肉芽組織 = 新生微血管、纖維母細胞、纖維組織及細胞外基質 |
| Epithelialization 上皮形成 | Basal epithelial cells keratinocytes 基底上皮細胞角質細胞 | migrate from edges, proliferate, and differentiate to form the new basement membrane 從邊緣遷移、增殖並分化形成新的基底膜 |
| Myofibroblasts 肌纖維母細胞 | contraction of the wound edges 傷口邊緣收縮 | |
| Maturation/Remodeling 成熟/重塑階段 | Epithelium 上皮組織 | collagen becomes thicker and more cross-linked 膠原蛋白變得更粗且交聯更緊密 |
| Myofibroblasts 肌纖維母細胞 | continued contraction 持續性收縮 |
Inflammatory Phase 發炎期
This phase begins at the time of wounding and continues until the debridement phase begins, usually at 6 to 12 hours postinitial injury. The first action in this phase is vasoconstriction due to the release by endothelial cells of catecholamines (epinephrine and norepinephrine) and prostaglandins.5,6 The primary role of vasoconstriction is to decrease blood loss from the wound, but this is reversed to a vasodilatory state within minutes to allow for the influx of platelets, and white and red blood cells to fill and clean the wound. Increased vascular permeability allows for cytokine and growth factor release from activated platelets to encourage chemotaxis of inflammatory cells. The release of thromboplastin initiates the extrinsic pathway of the clotting cascade and platelet aggregation. Fibrin cross-linking leads to primary clot formation within the wound bed. The end of this phase is generally considered when white blood cells begin to enter the wound to begin debridement.
此階段始於傷口形成時，並持續至清創階段開始（通常為受傷後 6 至 12 小時）。該階段的第一個反應是由內皮細胞釋放兒茶酚胺（腎上腺素和去甲腎上腺素）及前列腺素所引發的血管收縮。血管收縮的主要作用是減少傷口失血，但數分鐘內會轉變為血管擴張狀態，使血小板、白血球與紅血球得以進入傷口進行填充與清潔。血管通透性增加促使活化血小板釋放細胞因子與生長因子，吸引炎症細胞進行趨化作用。凝血活酶的釋放啟動了凝血級聯反應的外源性途徑與血小板聚集。纖維蛋白交聯導致傷口床形成初級血凝塊。當白血球開始進入傷口進行清創時，通常標誌著此階段的結束。
此階段始於傷口形成時，並持續至清創階段開始（通常為受傷後 6 至 12 小時）。該階段的第一個反應是由內皮細胞釋放兒茶酚胺（腎上腺素和去甲腎上腺素）及前列腺素所引發的血管收縮。血管收縮的主要作用是減少傷口失血，但數分鐘內會轉變為血管擴張狀態，使血小板、白血球與紅血球得以進入傷口進行填充與清潔。血管通透性增加促使活化血小板釋放細胞因子與生長因子，吸引炎症細胞進行趨化作用。凝血活酶的釋放啟動了凝血級聯反應的外源性途徑與血小板聚集。纖維蛋白交聯導致傷口床形成初級血凝塊。當白血球開始進入傷口進行清創時，通常標誌著此階段的結束。
Debridement Phase 清創階段
In this phase, neutrophils and monocytes migrate into the wound bed due to increased vascular permeability and phagocytose organisms and debris contaminating the wound. When neutrophils degenerate, they release enzymes and free radicals that kill the bacteria and break down the debris. Monocytes transform into macrophages and synthesize and secrete growth factors necessary for tissue formation and remodeling. Macrophages also stimulate angiogenesis and matrix production in wounds.7 Exudate is the hallmark of this phase and can be septic or nonseptic (Fig. 1).
在此階段，由於血管通透性增加，嗜中性球和單核球會遷移至傷口床，並吞噬污染傷口的微生物和碎屑。當嗜中性球退化時，會釋放酵素和自由基來殺死細菌並分解碎屑。單核球會轉化為巨噬細胞，合成並分泌組織形成和重塑所需的生長因子。巨噬細胞還會刺激傷口內的血管新生和基質生成。 7 滲出液是此階段的特徵，可能是感染性或非感染性的（圖 1）。
在此階段，由於血管通透性增加，嗜中性球和單核球會遷移至傷口床，並吞噬污染傷口的微生物和碎屑。當嗜中性球退化時，會釋放酵素和自由基來殺死細菌並分解碎屑。單核球會轉化為巨噬細胞，合成並分泌組織形成和重塑所需的生長因子。巨噬細胞還會刺激傷口內的血管新生和基質生成。 7 滲出液是此階段的特徵，可能是感染性或非感染性的（圖 1）。
Fig. 1. Photograph of an exudative wound caused by self-trauma before cleaning.
圖 1. 清潔前因自傷行為導致的滲出性傷口照片。
Repair/proliferation Phase
修復/增生階段
This phase is typically considered to include 3 distinct processes all overlapping in time: fibroplasia, angiogenesis, and epithelialization. During fibroplasia, fibroblasts originating from undifferentiated mesenchymal cells at the border of the wound begin to migrate into the fibrin clot. Fibroblast proliferation is stimulated by macrophages, cytokines, growth factors, and wound environment factors such as pH and oxygen content. Fibroblasts are also responsible for collagen and elastin synthesis. Usually, around day 5 postinjury tension acting on the wound will begin to reorient the disorganized fibroblasts, new blood vessels, and matrix parallel to the wound edges. Collagen content continues to increase in the wound bed until 2 to 3 weeks postinjury.
此階段通常被認為包含三個在時間上相互重疊的獨特過程：纖維增生、血管新生和上皮形成。在纖維增生過程中，源自傷口邊緣未分化間葉細胞的纖維母細胞開始遷移至纖維蛋白凝塊中。纖維母細胞的增生受到巨噬細胞、細胞激素、生長因子以及傷口環境因素（如 pH 值和氧含量）的刺激。纖維母細胞還負責膠原蛋白和彈性蛋白的合成。通常在受傷後第 5 天左右，作用於傷口的張力會開始將原本雜亂的纖維母細胞、新生血管和基質重新排列為與傷口邊緣平行的方向。傷口床中的膠原蛋白含量會持續增加，直到受傷後 2 至 3 週。
此階段通常被認為包含三個在時間上相互重疊的獨特過程：纖維增生、血管新生和上皮形成。在纖維增生過程中，源自傷口邊緣未分化間葉細胞的纖維母細胞開始遷移至纖維蛋白凝塊中。纖維母細胞的增生受到巨噬細胞、細胞激素、生長因子以及傷口環境因素（如 pH 值和氧含量）的刺激。纖維母細胞還負責膠原蛋白和彈性蛋白的合成。通常在受傷後第 5 天左右，作用於傷口的張力會開始將原本雜亂的纖維母細胞、新生血管和基質重新排列為與傷口邊緣平行的方向。傷口床中的膠原蛋白含量會持續增加，直到受傷後 2 至 3 週。
Angiogenesis is stimulated by cytokines and growth factors such as fibroblast growth factor, vascular endothelial cell growth factor, endothelial growth factor, and TGF-B. New capillaries give granulation tissue, its red color (Fig. 2). The formation of visible granulation tissue usually takes at least 4 to 5 days postinjury and is necessary for wound contraction as it acts as a scaffold for epithelial cell migration. Healthy granulation tissue is resistant to infection and has no nerve endings.
血管新生是由細胞因子和生長因子所刺激，例如纖維母細胞生長因子、血管內皮細胞生長因子、內皮生長因子和 TGF-B。新生的微血管賦予肉芽組織其紅色外觀（圖 2）。肉眼可見的肉芽組織通常在受傷後至少需要 4 至 5 天才能形成，這對於傷口收縮是必要的，因為它為上皮細胞遷移提供了支架。健康的肉芽組織具有抗感染能力且不含神經末梢。
血管新生是由細胞因子和生長因子所刺激，例如纖維母細胞生長因子、血管內皮細胞生長因子、內皮生長因子和 TGF-B。新生的微血管賦予肉芽組織其紅色外觀（圖 2）。肉眼可見的肉芽組織通常在受傷後至少需要 4 至 5 天才能形成，這對於傷口收縮是必要的，因為它為上皮細胞遷移提供了支架。健康的肉芽組織具有抗感染能力且不含神經末梢。
Fig. 2. Photograph of healthy red granulation tissue on a distal extremity wound on a dog. The wound had been managed to this point with NPWT.
圖 2. 犬隻遠端肢體傷口上健康紅色肉芽組織的照片。該傷口至此階段皆使用負壓傷口治療(NPWT)進行處理。
Epithelialization is the last component of this phase of healing and begins when keratinocytes begin to migrate across the granulation tissue. Epithelial cells are stimulated to proliferate by the secretion of cytokines and growth factors (endothelial growth factor, TGF-alpha) from platelets and macrophages. Epithelial migration continues until cells come in contact with each other across the wound bed (contact inhibition). Myofibroblasts play a central role in the contraction of the wound during this phase. Contraction is important as it is a principle factor in closing the wound but it can be associated with deleterious effects as well such as excessive scar tissue formation and contractures.8 The newly formed epithelial tissue is devoid of hair follicles or glands and is usually quite thin and fragile (Fig. 3).
上皮化是此癒合階段的最後一個環節，當角質細胞開始在肉芽組織上遷移時便開始進行。血小板和巨噬細胞分泌的細胞因子及生長因子（內皮生長因子、TGF-α）會刺激上皮細胞增殖。上皮細胞遷移會持續進行，直到細胞在傷口床相互接觸（接觸抑制）。在此階段，肌纖維母細胞於傷口收縮過程中扮演關鍵角色。收縮作用十分重要，因為它是閉合傷口的主要因素，但也可能伴隨有害影響，例如過度疤痕組織形成與攣縮。 8 新形成的上皮組織缺乏毛囊或腺體，通常非常薄且脆弱（圖 3）。
上皮化是此癒合階段的最後一個環節，當角質細胞開始在肉芽組織上遷移時便開始進行。血小板和巨噬細胞分泌的細胞因子及生長因子（內皮生長因子、TGF-α）會刺激上皮細胞增殖。上皮細胞遷移會持續進行，直到細胞在傷口床相互接觸（接觸抑制）。在此階段，肌纖維母細胞於傷口收縮過程中扮演關鍵角色。收縮作用十分重要，因為它是閉合傷口的主要因素，但也可能伴隨有害影響，例如過度疤痕組織形成與攣縮。 8 新形成的上皮組織缺乏毛囊或腺體，通常非常薄且脆弱（圖 3）。
Fig. 3. Photograph of ventral chin wound in different phases of healing. Epithelialization (new skin formation) is seen at edges as light pink fragile skin. Granulation tissue is present in the middle of the wound. Contraction is occurring to slowly reduce the size of this wound.
圖 3.下巴腹側傷口於不同癒合階段的照片。邊緣可見呈淡粉紅色脆弱皮膚的上皮化（新皮膚形成）現象。傷口中央存在肉芽組織。收縮作用正逐步縮小此傷口面積。
Maturation/Remodeling Phase
成熟/重塑階段
This phase begins approximately 1 week after the initial injury but lasts several months to years. During this time, the newly formed skin becomes stronger as the collagen fibers become thicker and more cross-linked. They orient along lines of tension of the body and myofibroblasts at the wound edges continue to contract to decrease the scar over time. The scar will eventually reach a strength that is 80% of the original tissue before injury.
此階段約在初始受傷後一週開始，但會持續數月至數年。在此期間，新形成的皮膚會隨著膠原纖維變得更粗且交聯程度增加而增強強度。這些纖維會沿著身體張力線排列，而傷口邊緣的肌纖維母細胞會持續收縮，隨著時間減少疤痕。最終疤痕將達到受傷前原始組織 80%的強度。
此階段約在初始受傷後一週開始，但會持續數月至數年。在此期間，新形成的皮膚會隨著膠原纖維變得更粗且交聯程度增加而增強強度。這些纖維會沿著身體張力線排列，而傷口邊緣的肌纖維母細胞會持續收縮，隨著時間減少疤痕。最終疤痕將達到受傷前原始組織 80%的強度。
Considerations for wound healing
傷口癒合考量因素
It is important to not only consider the cause of the wound or visual findings but also the chronicity of the wound, patient comorbidities and the location as these factors will play a large role in the prognosis for the patient. The difference between acute and chronic wounds is not only the potential increase in bacterial load but also the change in inflammatory cytokines found in wound fluid.9,10 An excess in matrix metalloproteinases and serine proteinases leads to a breakdown of the extracellular matrix and can halt the progression of the wound healing.
不僅需考慮傷口成因或視覺發現，傷口慢性程度、患者共病症及位置等因素也極為重要，這些都將大幅影響患者預後。急性與慢性傷口的差異不僅在於細菌負荷量可能增加，更在於傷口液中發炎性細胞因子的變化。基質金屬蛋白酶和絲氨酸蛋白酶過量會導致細胞外基質分解，可能阻礙傷口癒合進程。
不僅需考慮傷口成因或視覺發現，傷口慢性程度、患者共病症及位置等因素也極為重要，這些都將大幅影響患者預後。急性與慢性傷口的差異不僅在於細菌負荷量可能增加，更在於傷口液中發炎性細胞因子的變化。基質金屬蛋白酶和絲氨酸蛋白酶過量會導致細胞外基質分解，可能阻礙傷口癒合進程。
Patient comorbidities/factors affecting wound healing
影響傷口癒合的患者共病症/因素
Many different patient-related factors affect wound healing including age, preexisting medical conditions, and medications/treatments the patient has or is receiving (Table 2). While research is mixed regarding the effects of aging on wound healing, there is a reduction in dermal thickness and decreased microcirculation as aging progresses.2,11 It is likely that most effects seen in elderly dogs are due to concurrent disease processes, but delayed healing should still be planned for and primary closure pursued whenever possible for patients in this category. Wound-related factors include the amount and type of tissue damage, the presence of infection and foreign debris, and anatomic location of the injury.
許多不同的患者相關因素會影響傷口癒合，包括年齡、既存醫療狀況以及患者正在接受或已接受的藥物/治療（表 2）。雖然關於老化對傷口癒合影響的研究結果不一，但隨著年齡增長，真皮厚度會減少且微循環會下降。 2 11 老年犬所見的大多數影響很可能歸因於併發疾病過程，但仍應預期癒合延遲，並盡可能為此類患者進行初期閉合。與傷口相關的因素包括組織損傷的程度和類型、感染和異物是否存在，以及受傷的解剖位置。
許多不同的患者相關因素會影響傷口癒合，包括年齡、既存醫療狀況以及患者正在接受或已接受的藥物/治療（表 2）。雖然關於老化對傷口癒合影響的研究結果不一，但隨著年齡增長，真皮厚度會減少且微循環會下降。 2 11 老年犬所見的大多數影響很可能歸因於併發疾病過程，但仍應預期癒合延遲，並盡可能為此類患者進行初期閉合。與傷口相關的因素包括組織損傷的程度和類型、感染和異物是否存在，以及受傷的解剖位置。
Table 2. Patient considerations for wound healing
表 2. 傷口癒合的患者考量因素
| Age 年齡 | Reduction in dermal thickness, decreased microcirculation 真皮厚度減少，微循環下降 |
| Comorbidities 併發症 | Diabetes, Cushings, Liver disease, Immune-mediated diseases (IMHA, ITP), malnutrition, kidney disease, neoplasia 糖尿病、庫欣氏症、肝臟疾病、免疫介導疾病（IMHA、ITP）、營養不良、腎臟疾病、腫瘤 |
| Medications 藥物治療 | Steroids, NSAIDs, chemotherapy 類固醇、非類固醇抗發炎藥（NSAIDs）、化療藥物 |
| Radiation therapy to the site 放射治療部位 | fibrotic microangiopathy 纖維化微血管病變 |
Metabolic Diseases 代謝性疾病
While veterinary patients do suffer from many metabolic diseases, they do not smoke cigarettes or drink alcohol which can account for serious complications in wound healing in humans. We also do not see vascular diseases (atherosclerosis and thrombosis) as commonly in our pet population. The common metabolic disease we encounter include diabetes mellitus, hyperadrenocorticism, kidney, and liver disease.2,12 These diseases are theorized to delay wound healing by decreasing the inflammatory response to wounds, which impairs chemotaxis of inflammatory cells and reduces bacterial destruction. However, clear causation has yet to be seen as wound healing is multifactorial. While malnutrition can easily affect wound healing, especially in patients with neoplasia, but this is not as common a phenomenon in veterinary medicine. Nutritional status is especially important for the healing of highly exudative wounds such as burns and all efforts should be made to keep patients' total protein above 2.0 g/dL.
雖然獸醫病患確實會罹患許多代謝性疾病，但牠們不會吸菸或飲酒，而這些行為在人類身上可能導致傷口癒合出現嚴重併發症。我們在寵物族群中也較少見到血管疾病（動脈粥樣硬化和血栓形成）。常見的代謝性疾病包括糖尿病、腎上腺皮質功能亢進、腎臟和肝臟疾病。理論上這些疾病會通過降低對傷口的炎症反應來延遲傷口癒合，從而損害炎症細胞的趨化性並減少細菌的破壞。然而，由於傷口癒合是多因素影響的過程，目前尚未觀察到明確的因果關係。雖然營養不良容易影響傷口癒合，特別是在患有腫瘤的病患中，但這種現象在獸醫領域並不常見。營養狀態對於高度滲出性傷口（如燒傷）的癒合尤其重要，應盡一切努力使病患的總蛋白質維持在 2.0 g/dL 以上。
雖然獸醫病患確實會罹患許多代謝性疾病，但牠們不會吸菸或飲酒，而這些行為在人類身上可能導致傷口癒合出現嚴重併發症。我們在寵物族群中也較少見到血管疾病（動脈粥樣硬化和血栓形成）。常見的代謝性疾病包括糖尿病、腎上腺皮質功能亢進、腎臟和肝臟疾病。理論上這些疾病會通過降低對傷口的炎症反應來延遲傷口癒合，從而損害炎症細胞的趨化性並減少細菌的破壞。然而，由於傷口癒合是多因素影響的過程，目前尚未觀察到明確的因果關係。雖然營養不良容易影響傷口癒合，特別是在患有腫瘤的病患中，但這種現象在獸醫領域並不常見。營養狀態對於高度滲出性傷口（如燒傷）的癒合尤其重要，應盡一切努力使病患的總蛋白質維持在 2.0 g/dL 以上。
Medications and Treatments
藥物與治療
Many medications can affect wound healing; therefore, we will briefly mention the most relevant to veterinary medicine. The most common medication that can delay wound healing is steroids. Glucocorticoids cause epidermal and granulation tissue atrophy, impair macrophage activity, fibroblast proliferation, and collagen synthesis, and they inhibit the synthesis of matrix metalloproteinases. All of these actions delay wound healing and reduce wound tensile strength and are time and dose dependent.2,13,14 Not surprisingly nonsteroidal antiinflammatory medications have also been shown to have an effect on wound healing because they suppress the inflammatory phase.2,15 This class of medication is commonly used in veterinary medicine for pain relief from trauma and surgery but considerations to the potentially significant delay in wound healing should be weighed. Chemotherapeutic agents may also result in delays in wound healing owing to their mechanism of action.
許多藥物會影響傷口癒合，因此我們將簡要提及與獸醫學最相關的部分。最常見可能延遲傷口癒合的藥物是類固醇。糖皮質激素會導致表皮和肉芽組織萎縮，損害巨噬細胞活性、纖維母細胞增殖和膠原蛋白合成，並抑制基質金屬蛋白酶合成。所有這些作用都會延遲傷口癒合並降低傷口抗張強度，且具有時間和劑量依賴性。 2 13 14 毫不意外地，非類固醇抗發炎藥物也被證實會影響傷口癒合，因為它們會抑制發炎階段。 2 15 這類藥物在獸醫學中常用於創傷和手術後的疼痛緩解，但應權衡其可能對傷口癒合造成的顯著延遲。化療藥物也可能因其作用機制而導致傷口癒合延遲。
As they attack rapidly dividing cells, through cytotoxic (nitrogen mustards and methylating agents), antiproliferative (microtubule stabilizers, DNA synthesis inhibitors, and antiangiogenic agents), or antimetabolic (folic acid synthesis inhibitors) mechanisms, wound healing is inhibited. All of these pathways are executed by epithelial, fibroblast, and white blood cells during normal wound healing and therefore, wound strength and rate are affected.16
由於這些藥物透過細胞毒性（氮芥和甲基化劑）、抗增殖（微管穩定劑、DNA 合成抑制劑和抗血管生成劑）或抗代謝（葉酸合成抑制劑）機制攻擊快速分裂的細胞，因此會抑制傷口癒合。所有這些途徑在正常傷口癒合過程中都是由上皮細胞、纖維母細胞和白血球執行，因此會影響傷口的強度和癒合速率。 16
許多藥物會影響傷口癒合，因此我們將簡要提及與獸醫學最相關的部分。最常見可能延遲傷口癒合的藥物是類固醇。糖皮質激素會導致表皮和肉芽組織萎縮，損害巨噬細胞活性、纖維母細胞增殖和膠原蛋白合成，並抑制基質金屬蛋白酶合成。所有這些作用都會延遲傷口癒合並降低傷口抗張強度，且具有時間和劑量依賴性。 2 13 14 毫不意外地，非類固醇抗發炎藥物也被證實會影響傷口癒合，因為它們會抑制發炎階段。 2 15 這類藥物在獸醫學中常用於創傷和手術後的疼痛緩解，但應權衡其可能對傷口癒合造成的顯著延遲。化療藥物也可能因其作用機制而導致傷口癒合延遲。
As they attack rapidly dividing cells, through cytotoxic (nitrogen mustards and methylating agents), antiproliferative (microtubule stabilizers, DNA synthesis inhibitors, and antiangiogenic agents), or antimetabolic (folic acid synthesis inhibitors) mechanisms, wound healing is inhibited. All of these pathways are executed by epithelial, fibroblast, and white blood cells during normal wound healing and therefore, wound strength and rate are affected.16
由於這些藥物透過細胞毒性（氮芥和甲基化劑）、抗增殖（微管穩定劑、DNA 合成抑制劑和抗血管生成劑）或抗代謝（葉酸合成抑制劑）機制攻擊快速分裂的細胞，因此會抑制傷口癒合。所有這些途徑在正常傷口癒合過程中都是由上皮細胞、纖維母細胞和白血球執行，因此會影響傷口的強度和癒合速率。 16
Radiation therapy affects tissue, fibroblasts, and growth factor production, as well as local vasculature.17 The decrease in vasculature at a radiated site is due to a process called fibrotic microangiopathy. This is theorized to decrease oxygen content to below what is needed for normal wound healing.18,19 Recommendations currently are to radiate before surgery if you can remove that region with your definitive procedure or to wait until incisions are well healing if we are planning to radiate the site postoperatively.
放射治療會影響組織、纖維母細胞和生長因子的產生，以及局部血管系統。 17 放射部位血管系統的減少是由於一種稱為纖維化微血管病變的過程。理論上這會使氧氣含量降低至低於正常傷口癒合所需的水平。 18 19 目前的建議是，如果能在確定性手術中切除該區域，則在術前進行放射治療；或者如果計劃在術後對該部位進行放射治療，則等待切口完全癒合後再進行。
放射治療會影響組織、纖維母細胞和生長因子的產生，以及局部血管系統。 17 放射部位血管系統的減少是由於一種稱為纖維化微血管病變的過程。理論上這會使氧氣含量降低至低於正常傷口癒合所需的水平。 18 19 目前的建議是，如果能在確定性手術中切除該區域，則在術前進行放射治療；或者如果計劃在術後對該部位進行放射治療，則等待切口完全癒合後再進行。
Immunosuppression/Cancer 免疫抑制/癌症
Immune-mediated diseases such as immune-mediated hemolytic anemia, thrombocytopenia, and erosive polyarthritis have abnormal inflammatory responses and therefore, atypical wound healing responses, but it may also be that the treatments for these diseases (glucocorticoids and chemotherapeutic agents) are what truly delay wound healing. Delayed healing in patients with cancer may be seen with cancer-related malnutrition or due to the chronic inflammation and dysregulation of proliferation and angiogenesis pathways seen with neoplastic processes.2,20,21
免疫介導性疾病如免疫介導性溶血性貧血、血小板減少症和侵蝕性多關節炎會出現異常的炎症反應，因此傷口癒合反應也不典型，但這些疾病的治療藥物（糖皮質激素和化療藥物）可能才是真正延遲傷口癒合的原因。癌症患者可能因癌症相關營養不良，或由於腫瘤病變導致的慢性炎症及增殖與血管生成途徑失調，而出現傷口癒合延遲。 2 20 21
免疫介導性疾病如免疫介導性溶血性貧血、血小板減少症和侵蝕性多關節炎會出現異常的炎症反應，因此傷口癒合反應也不典型，但這些疾病的治療藥物（糖皮質激素和化療藥物）可能才是真正延遲傷口癒合的原因。癌症患者可能因癌症相關營養不良，或由於腫瘤病變導致的慢性炎症及增殖與血管生成途徑失調，而出現傷口癒合延遲。 2 20 21
Wound factors 傷口因素
Wound-related considerations usually take center stage when assessing for treatment options and prognosis for healing (Table 3). Whereby on the body the wound occurred, how much damage was experienced, and the presence of infection or foreign material are the most relevant factors to consider.
評估治療方案和癒後預測時，傷口相關考量通常佔據核心地位（表 3）。傷口發生的身體部位、受損程度，以及是否存在感染或異物，是最需要考量的相關因素。
評估治療方案和癒後預測時，傷口相關考量通常佔據核心地位（表 3）。傷口發生的身體部位、受損程度，以及是否存在感染或異物，是最需要考量的相關因素。
Table 3. Wound-related consideration for wound healing
表 3. 影響傷口癒合的傷口相關考量
| Anatomic location 解剖位置 | Extremities, head, tail, oral cavity, inguinal, axillary regions 四肢、頭部、尾部、口腔、腹股溝、腋窩區域 |
| Motion 動作 | Joints, tails, weight-bearing surfaces 關節、尾部、負重表面 |
| Tension 張力 | Related to motion, dependent on patient skin elasticity and thickness 與運動相關，取決於患者皮膚彈性和厚度 |
| Extent of tissue damage 組織損傷程度 | nonviable tissue, damage to perfusion 無活性組織，血液灌注受損 |
| Infection 感染 | produce inflammatory mediators/cytokines, trigger cell death 產生發炎介質/細胞激素，引發細胞死亡 |
| Implants 植入物 | sensitive to biofilm production 易於形成生物膜 |
Anatomic Considerations 解剖學考量
When discussing anatomic considerations related to wound healing 3 factors are the most important for surgical planning and prognosis. The location of the wound on the body, the amount of motion the wound will undergo and the available skin in the region and its elasticity. Location is clearly significant as there is no extra skin or subcutaneous tissues overlying the limbs, head, or tail and the inguinal and axillary regions can be prone to complications due to inherent dead space and motion (Fig. 4). Motion is inherent in certain sites on the body, such as over joints, the tail, and the oral cavity. In areas whereby weight-bearing will be anticipated bandages are commonly used but motion can occur within the bandage if it is not applied properly. Tension of the skin in the area of the wound should be assessed preoperatively.
在討論與傷口癒合相關的解剖學考量時，有三個因素對手術規劃和預後最為重要：傷口在身體上的位置、傷口將承受的活動量，以及該區域可用皮膚及其彈性。位置顯然至關重要，因為四肢、頭部或尾部上方沒有多餘的皮膚或皮下組織，而腹股溝和腋窩區域由於固有的死腔和活動性容易出現併發症（圖 4）。身體某些部位（如關節上方、尾部和口腔）本身就會活動。在預期會承受重量的區域通常會使用繃帶，但如果繃帶包紮不當，仍可能發生內部移動。應在術前評估傷口區域皮膚的張力。
Pinching and moving the available skin while the patient is anesthetized will allow the surgeon to determine whether a primary closure is even possible. Multiple tension-relieving suture patterns and techniques are available to aid in tricky closure, but some wounds are simply too large to close initially.3,4 Different breeds and species have varied elasticity to their skin. Cats, for example, have very elastic skin that can be easily stretched to close large wounds. Certain dog breeds with thick nonelastic skin will be much more challenging to address surgically. Changes in tension during normal range of motion should always be assessed before definitive closure so that appropriate surgical steps or postoperative management strategies (bandages, hobbles, and so forth) can be used. Excessive motion and tension can lead to dehiscence, damaged blood supply, and eventual necrosis of the skin. If excessive tension is applied circumferentially (limbs, tail, and so forth), disruption in vascular supply and lymphatic drainage can occur causing congestion and swelling of the limb (Fig. 5). Advanced therapeutics such as negative pressure wound therapy (NPWT) (discussed later in this chapter) can be used to decrease tension and medicinal leech therapy can be effectively used for constrictive swelling.22
在患者麻醉狀態下捏起並移動可用皮膚，可讓外科醫師判斷是否可能進行初期縫合。雖然有多種減張縫合模式與技術可協助處理困難的閉合情況，但某些傷口初期就是過大而無法直接縫合。 3 4 不同品種與物種的皮膚彈性各異，例如貓的皮膚極具彈性，可輕易拉伸以閉合大型傷口；而某些皮膚厚實缺乏彈性的犬種，手術處理難度將大幅提高。在最終縫合前，必須評估正常活動範圍內的張力變化，以便採取適當手術步驟或術後管理策略（如繃帶、限制裝置等）。過度活動與張力可能導致傷口裂開、血液供應受損，最終造成皮膚壞死。若在環狀部位（四肢、尾部等）施加過度張力，可能破壞血管供應與淋巴引流，導致肢體充血腫脹（圖 5）。 諸如負壓傷口治療（NPWT）（本章後續將討論）等先進治療方式可用於減輕傷口張力，而醫用水蛭療法則能有效處理收縮性腫脹。 22
在討論與傷口癒合相關的解剖學考量時，有三個因素對手術規劃和預後最為重要：傷口在身體上的位置、傷口將承受的活動量，以及該區域可用皮膚及其彈性。位置顯然至關重要，因為四肢、頭部或尾部上方沒有多餘的皮膚或皮下組織，而腹股溝和腋窩區域由於固有的死腔和活動性容易出現併發症（圖 4）。身體某些部位（如關節上方、尾部和口腔）本身就會活動。在預期會承受重量的區域通常會使用繃帶，但如果繃帶包紮不當，仍可能發生內部移動。應在術前評估傷口區域皮膚的張力。
Pinching and moving the available skin while the patient is anesthetized will allow the surgeon to determine whether a primary closure is even possible. Multiple tension-relieving suture patterns and techniques are available to aid in tricky closure, but some wounds are simply too large to close initially.3,4 Different breeds and species have varied elasticity to their skin. Cats, for example, have very elastic skin that can be easily stretched to close large wounds. Certain dog breeds with thick nonelastic skin will be much more challenging to address surgically. Changes in tension during normal range of motion should always be assessed before definitive closure so that appropriate surgical steps or postoperative management strategies (bandages, hobbles, and so forth) can be used. Excessive motion and tension can lead to dehiscence, damaged blood supply, and eventual necrosis of the skin. If excessive tension is applied circumferentially (limbs, tail, and so forth), disruption in vascular supply and lymphatic drainage can occur causing congestion and swelling of the limb (Fig. 5). Advanced therapeutics such as negative pressure wound therapy (NPWT) (discussed later in this chapter) can be used to decrease tension and medicinal leech therapy can be effectively used for constrictive swelling.22
在患者麻醉狀態下捏起並移動可用皮膚，可讓外科醫師判斷是否可能進行初期縫合。雖然有多種減張縫合模式與技術可協助處理困難的閉合情況，但某些傷口初期就是過大而無法直接縫合。 3 4 不同品種與物種的皮膚彈性各異，例如貓的皮膚極具彈性，可輕易拉伸以閉合大型傷口；而某些皮膚厚實缺乏彈性的犬種，手術處理難度將大幅提高。在最終縫合前，必須評估正常活動範圍內的張力變化，以便採取適當手術步驟或術後管理策略（如繃帶、限制裝置等）。過度活動與張力可能導致傷口裂開、血液供應受損，最終造成皮膚壞死。若在環狀部位（四肢、尾部等）施加過度張力，可能破壞血管供應與淋巴引流，導致肢體充血腫脹（圖 5）。 諸如負壓傷口治療（NPWT）（本章後續將討論）等先進治療方式可用於減輕傷口張力，而醫用水蛭療法則能有效處理收縮性腫脹。 22
Fig. 4. Photograph of open wound at axilla. Due to constant motion, this wound dehisced multiple times after attempted closure and was eventually managed as an open wound and allowed to heal by second intention.
圖 4. 腋窩開放性傷口照片。由於持續活動，此傷口在嘗試閉合後多次裂開，最終以開放性傷口方式處理，使其透過二期癒合自然痊癒。
Fig. 5. Photographs of a constrictive wound from a bandage with distal limb swelling. Two leeches were applied to this patient's paw to aid in venous constriction.
圖 5. 繃帶造成之束縛性傷口併遠端肢體腫脹的照片。該病患的腳掌上放置了兩隻水蛭以協助靜脈收縮。
Tissue Damage 組織損傷
The severity of tissue damage is usually the first physical examination finding that doctors assess during the initial evaluation. Due to the complex nature of wounds and various injuries that can occur (crushing, degloving, puncture, and so forth), the full extent of damage is not always clear. This is easily described with the “tip of the iceberg” analogy.
組織損傷的嚴重程度通常是醫師在初次評估時首要檢查的發現。由於傷口的複雜性及可能發生的各種損傷（擠壓傷、脫套傷、穿刺傷等），損傷的全貌往往無法立即明確。這種情況很容易用「冰山一角」的比喻來描述。
It is extremely important for client communications to include a discussion of the risk of ongoing tissue destruction due to damage to microcirculation or ongoing inflammatory mediators. The amount of damage can be assessed for the amount of tissue that is missing or clearly nonviable (black/gray, leather-like) and the amount that may have decreased or damaged perfusion. Clearly nonviable tissue (Fig. 6) must be debrided but tissue with reduced but present perfusion should be maintained if possible. A healthy blood supply is required for normal wound healing. Poor perfusion can be due to trauma to the vascular supply, systemic factors such as hypotension or hypovolemia, or comorbidities (diabetes).
在與客戶溝通時，必須討論由於微循環受損或持續性發炎介質所導致的組織持續破壞風險，這點極為重要。組織損傷程度可透過評估缺失或明顯無存活能力的組織量（黑色/灰色、皮革樣），以及可能出現灌注減少或受損的組織量來判斷。明顯無存活能力的組織（圖 6）必須進行清創，但對於灌注減少但仍存在的組織，應盡可能予以保留。正常傷口癒合需要健康的血液供應。灌注不良可能由血管供應創傷、全身性因素（如低血壓或低血容量）或共病症（如糖尿病）所導致。
組織損傷的嚴重程度通常是醫師在初次評估時首要檢查的發現。由於傷口的複雜性及可能發生的各種損傷（擠壓傷、脫套傷、穿刺傷等），損傷的全貌往往無法立即明確。這種情況很容易用「冰山一角」的比喻來描述。
It is extremely important for client communications to include a discussion of the risk of ongoing tissue destruction due to damage to microcirculation or ongoing inflammatory mediators. The amount of damage can be assessed for the amount of tissue that is missing or clearly nonviable (black/gray, leather-like) and the amount that may have decreased or damaged perfusion. Clearly nonviable tissue (Fig. 6) must be debrided but tissue with reduced but present perfusion should be maintained if possible. A healthy blood supply is required for normal wound healing. Poor perfusion can be due to trauma to the vascular supply, systemic factors such as hypotension or hypovolemia, or comorbidities (diabetes).
在與客戶溝通時，必須討論由於微循環受損或持續性發炎介質所導致的組織持續破壞風險，這點極為重要。組織損傷程度可透過評估缺失或明顯無存活能力的組織量（黑色/灰色、皮革樣），以及可能出現灌注減少或受損的組織量來判斷。明顯無存活能力的組織（圖 6）必須進行清創，但對於灌注減少但仍存在的組織，應盡可能予以保留。正常傷口癒合需要健康的血液供應。灌注不良可能由血管供應創傷、全身性因素（如低血壓或低血容量）或共病症（如糖尿病）所導致。
Fig. 6. Photographs of a patient who sustained a rattlesnake bit to ventral chin & neck weeks before presentation. Patient is anesthetized with nose to the right. (A) ventral surface of chin with clear demarcation of necrotic tissue. (B) when the tissue was gently lifted away from chin, thick exudate is present and visible muscle seen deep into the wound.
圖 6. 一名患者在就診數週前遭響尾蛇咬傷下巴及頸部腹側的攝影照片。患者處於麻醉狀態，鼻子朝向右側。(A)下巴腹側表面可見壞死組織的明顯分界線。(B)當輕輕掀起下巴組織時，可見濃厚滲出液及傷口深處暴露的肌肉組織。
Crush and wrenching injuries, most commonly seen with bite wounds, can severely compromise the blood supply to the region surrounding the obvious wound. In these cases, wounds can be addressed satisfactorily initially only to have ongoing tissue loss hours to days later as the true extent of the damage becomes evident.
擠壓和扭傷（最常見於咬傷）可能嚴重損害明顯傷口周圍區域的血液供應。在這些情況下，傷口初期可能看似處理得當，但隨著損傷真實程度逐漸顯現，數小時至數天後仍可能持續出現組織壞死。
Oxygen delivery to wound beds and healing tissues is paramount to a smooth recovery and is affected by intercapillary distances and peripheral vasoconstriction more than the patients packed cell volume.2 Because of this hyperbaric oxygen therapy (HBOT) has been recommended for various wounds in human and veterinary medicine. As we will discuss later in the chapter, the evidence is not consistent with regard to HBOT's efficacy.
傷口床與癒合組織的氧氣供應對於順利康復至關重要，其影響因素更多取決於微血管間距與周邊血管收縮，而非患者的血球容積比。 2 因此高壓氧治療(HBOT)在人類與獸醫領域被推薦用於多種傷口類型。如本章後續將討論的，關於 HBOT 療效的實證結果尚不一致。
擠壓和扭傷（最常見於咬傷）可能嚴重損害明顯傷口周圍區域的血液供應。在這些情況下，傷口初期可能看似處理得當，但隨著損傷真實程度逐漸顯現，數小時至數天後仍可能持續出現組織壞死。
Oxygen delivery to wound beds and healing tissues is paramount to a smooth recovery and is affected by intercapillary distances and peripheral vasoconstriction more than the patients packed cell volume.2 Because of this hyperbaric oxygen therapy (HBOT) has been recommended for various wounds in human and veterinary medicine. As we will discuss later in the chapter, the evidence is not consistent with regard to HBOT's efficacy.
傷口床與癒合組織的氧氣供應對於順利康復至關重要，其影響因素更多取決於微血管間距與周邊血管收縮，而非患者的血球容積比。 2 因此高壓氧治療(HBOT)在人類與獸醫領域被推薦用於多種傷口類型。如本章後續將討論的，關於 HBOT 療效的實證結果尚不一致。
Infection/Foreign Debris/Implants
感染/異物殘留/植入物
The classifications of wound based on their contamination levels are thoroughly detailed elsewhere1, 2, 3 but infection and debris within wounds are an important factor relating to treatment and prognosis. The appropriate treatment of wounds depends on differentiating between clean, contaminated, and infected. Clean and clean-contaminated wounds should heal routinely with no/minimal prophylactic antibiosis if the animal is otherwise healthy and tissue damage is minimal. Contaminated wounds have obvious debris and or presumed bacteria present in numbers lower than 105 per gram of tissue. Infected wounds (Fig. 7) have a higher bacterial load and usually illustrate a host response (redness, pain, swelling, exudate). Bacteria produce inflammatory mediators that interfere with multiple steps of the healing process as well trigger cell death in the surrounding tissue.23, 24, 25 Any patient with visible debris or exudate should undergo thorough lavage and debridement before any attempt at closure is performed. The most common closure times for infected wounds are after the inflammatory and debridement phases when healthy granulation tissue is present. The presence of implants in wounds can complicate healing due to the possibility of biofilm production in the face of bacterial contamination. Successful healing of wounds with implants has been documented, however, but advanced and lengthy healing processes are necessary.26
根據傷口污染程度的分類在其他文獻 1,2,3 中已有詳細說明，但傷口內的感染和異物是影響治療與預後的重要因素。適當的傷口治療取決於區分清潔傷口、污染傷口和感染傷口。若動物本身健康且組織損傷輕微，清潔與清潔-污染傷口應能在不使用/最小量預防性抗生素的情況下正常癒合。污染傷口含有明顯異物和/或推定每克組織中細菌數量低於 10 5 的細菌。感染傷口（圖 7）則具有更高的細菌負荷，通常會引發宿主反應（發紅、疼痛、腫脹、滲出液）。細菌產生的炎症介質不僅會干擾癒合過程的多個步驟，還會引發周圍組織細胞死亡 23,24,25。任何可見異物或滲出液的患者，在嘗試閉合傷口前都應進行徹底沖洗和清創。感染傷口最常見的閉合時機是在炎症期和清創期之後，當出現健康肉芽組織時。 傷口內存在植入物可能使癒合過程複雜化，這是由於細菌污染時可能產生生物膜。然而，已有文獻記載植入物傷口成功癒合的案例，但需要更先進且漫長的癒合過程。 26
根據傷口污染程度的分類在其他文獻 1,2,3 中已有詳細說明，但傷口內的感染和異物是影響治療與預後的重要因素。適當的傷口治療取決於區分清潔傷口、污染傷口和感染傷口。若動物本身健康且組織損傷輕微，清潔與清潔-污染傷口應能在不使用/最小量預防性抗生素的情況下正常癒合。污染傷口含有明顯異物和/或推定每克組織中細菌數量低於 10 5 的細菌。感染傷口（圖 7）則具有更高的細菌負荷，通常會引發宿主反應（發紅、疼痛、腫脹、滲出液）。細菌產生的炎症介質不僅會干擾癒合過程的多個步驟，還會引發周圍組織細胞死亡 23,24,25。任何可見異物或滲出液的患者，在嘗試閉合傷口前都應進行徹底沖洗和清創。感染傷口最常見的閉合時機是在炎症期和清創期之後，當出現健康肉芽組織時。 傷口內存在植入物可能使癒合過程複雜化，這是由於細菌污染時可能產生生物膜。然而，已有文獻記載植入物傷口成功癒合的案例，但需要更先進且漫長的癒合過程。 26
Fig. 7. Photographs of a patient who suffered from a malicious constrictive injury (a leash was placed for many weeks to muzzle the dog). (A) Patient anesthetized. Obvious exudate is present at the maxillary lip but the extent of wound is difficult to assess. (B) After clipping and cleaning the full extent is now visible. Full-thickness skin wound with evidence of some granulation tissue present on the maxillary lip and nasal skin defect. (C) Primary closure of maxillary/nasal skin wound.
圖 7. 遭受惡性束縛性損傷（使用牽引帶長時間套住犬隻口鼻部）患者的照片。(A)麻醉狀態下的患者。上頜唇部可見明顯滲出液，但傷口範圍難以評估。(B)經修剪清潔後，完整傷口範圍清晰可見。上頜唇部全層皮膚缺損伴隨部分肉芽組織形成，鼻部皮膚缺損。(C)上頜/鼻部皮膚傷口的一期閉合。
Species differences 物種差異
Differences between cats and dogs are highly important with regards to wound healing (Box 1). If ever there was an aspect of veterinary medicine whereby the adage “Cats aren't small dogs” rings true it is with wound management. Dogs and cats have differences in their vascular anatomy with dogs having a greater density of collateral subcutaneous trunk vessels.27, 28, 29 This increase in density leads to an increase in tissue perfusion and therefore faster healing. Studies have shown that primarily closed incisions on cats are only half as strong as dog wounds by day 7 postinjury and cats have decreased cutaneous perfusion compared with dogs during this time.27 When second intention healing in cats was studied, less granulation tissue developed compared with dogs and it was located peripherally in the wound as compared centrally in dogs.
貓與狗在傷口癒合方面存在極重要的差異（見表 1）。若說獸醫學中有哪個領域最能體現「貓不是小型犬」這句格言，那必定是傷口管理。犬貓的血管解剖結構存在差異，犬隻擁有更密集的皮下主幹血管側支網絡[27,28,29]。這種血管密度的增加會提升組織灌注量，從而加速癒合過程。研究顯示，貓咪初期閉合性切口在受傷後第 7 天的強度僅為犬隻的一半，且在此期間貓的皮膚灌注量也較犬隻為低。 27 針對貓咪二期癒合的研究發現，其肉芽組織生成量較犬隻少，且多位於傷口邊緣（犬隻則主要集中於傷口中央）。
Granulation tissue also seemed earlier for dogs (4.5 days vs 6.3 days) compared with cats with the complete granulation of the wound bed not occurring for cats until a mean of 19 days (compared with dogs 7.5 days). Effects on epithelialization and contraction were also seen with a marked difference between epithelialization at 14 days with a mean of 44% of the canine wound areas re-epithelialized compared with just 13% of the feline wounds. The slow rate of granulation tissue formation has been theorized to increase contraction and healing times in cats (Fig. 8). Another study determined the removal of subcutaneous tissue in either species was associated with a significant decrease in rates of granulation tissue formation and contraction, but this was seen more dramatically in cats.28 Careful debridement of surrounding tissue, especially subcutaneous fat should be performed with cats to reduce the devitalization of the remaining skin.
犬隻的肉芽組織形成似乎比貓咪更早（4.5 天 vs 6.3 天），且貓咪傷口床完全肉芽化的平均時間長達 19 天（犬隻僅需 7.5 天）。上皮化和收縮效應也呈現顯著差異，14 天時犬隻傷口平均有 44%面積完成上皮化，而貓咪僅有 13%。理論認為貓咪肉芽組織形成速度緩慢會增加傷口收縮與癒合時間（圖 8）。另一項研究指出，無論哪種物種，皮下組織的移除都會顯著降低肉芽組織形成與收縮速率，但此現象在貓咪身上更為明顯。 28 對貓咪進行周邊組織清創時（尤其是皮下脂肪），應特別謹慎以減少剩餘皮膚的壞死。
貓與狗在傷口癒合方面存在極重要的差異（見表 1）。若說獸醫學中有哪個領域最能體現「貓不是小型犬」這句格言，那必定是傷口管理。犬貓的血管解剖結構存在差異，犬隻擁有更密集的皮下主幹血管側支網絡[27,28,29]。這種血管密度的增加會提升組織灌注量，從而加速癒合過程。研究顯示，貓咪初期閉合性切口在受傷後第 7 天的強度僅為犬隻的一半，且在此期間貓的皮膚灌注量也較犬隻為低。 27 針對貓咪二期癒合的研究發現，其肉芽組織生成量較犬隻少，且多位於傷口邊緣（犬隻則主要集中於傷口中央）。
Granulation tissue also seemed earlier for dogs (4.5 days vs 6.3 days) compared with cats with the complete granulation of the wound bed not occurring for cats until a mean of 19 days (compared with dogs 7.5 days). Effects on epithelialization and contraction were also seen with a marked difference between epithelialization at 14 days with a mean of 44% of the canine wound areas re-epithelialized compared with just 13% of the feline wounds. The slow rate of granulation tissue formation has been theorized to increase contraction and healing times in cats (Fig. 8). Another study determined the removal of subcutaneous tissue in either species was associated with a significant decrease in rates of granulation tissue formation and contraction, but this was seen more dramatically in cats.28 Careful debridement of surrounding tissue, especially subcutaneous fat should be performed with cats to reduce the devitalization of the remaining skin.
犬隻的肉芽組織形成似乎比貓咪更早（4.5 天 vs 6.3 天），且貓咪傷口床完全肉芽化的平均時間長達 19 天（犬隻僅需 7.5 天）。上皮化和收縮效應也呈現顯著差異，14 天時犬隻傷口平均有 44%面積完成上皮化，而貓咪僅有 13%。理論認為貓咪肉芽組織形成速度緩慢會增加傷口收縮與癒合時間（圖 8）。另一項研究指出，無論哪種物種，皮下組織的移除都會顯著降低肉芽組織形成與收縮速率，但此現象在貓咪身上更為明顯。 28 對貓咪進行周邊組織清創時（尤其是皮下脂肪），應特別謹慎以減少剩餘皮膚的壞死。
Box 1 方框 1
Differences between dogs and cats in wound healing
犬貓傷口癒合差異
犬貓傷口癒合差異
| Anatomy | Dogs have higher density of collateral subcutaneous trunk vessels |
| Primary closure incisions | breaking strength 50% less at 7 d in cats (equal by 14 d) |
| Decreased skin perfusion during the first week of healing in cats | |
| Second intention healing | |
| Granulation | Cats: less granulation tissue, peripheral location, granulation tissue took a mean of 6.3 d to seem and a mean of 19 d to cover the wound |
| Dogs: more granulation tissue, central location, granulation tissue took a mean of 4.5 d to appear and a mean of 7.5 to cover the wound | |
| Epithelialization | Cats: only 13% of the wound bed area was re-epithelialized by day 14 |
| Dogs: 44% of the wound bed area was re-epithelialized by day 14 |
Fig. 8. Photograph of wound on dorsum of cat near the tail base that is being managed with a tie over bandage. Wound seems clean but no evidence of granulation tissue is yet present. This is 7 days after the initial presentation and debridement.
圖 8. 貓尾基部附近背部傷口照片，採用覆蓋式繃帶處理。傷口看似清潔但尚未出現肉芽組織跡象。此為初次就診及清創後第 7 天狀況。
Update on wound management strategies
傷口管理策略最新進展
The following updates will summarize the mechanism of action and previous literature regarding each modality as well as new research and application advice. A brief outline of what phase of healing each modality can be found in Table 4.
以下更新內容將總結各項治療方式的作用機制、既有文獻資料，以及最新研究與應用建議。表 4 簡要列出各治療方式適用之傷口癒合階段。
以下更新內容將總結各項治療方式的作用機制、既有文獻資料，以及最新研究與應用建議。表 4 簡要列出各治療方式適用之傷口癒合階段。
Table 4. Wound dressings, mechanisms, and best time to apply
表 4. 傷口敷料類型、作用機制與最佳使用時機
| Dressing Name 敷料名稱 | Proposed Mechanism of Action 建議作用機制 | Application times Tested 測試應用次數 |
|---|---|---|
| NWPT |
| Contaminated/Infection open wounds in inflammatory or debridement phase 受污染/感染的開放性傷口處於炎症或清創階段 |
| ||
| ||
| ||
| Free skin grafts or flaps 游離皮片或皮瓣移植 | |
| Primarily closed at-risk incisions 高風險切口初期閉合 | ||
| Tilapia/Cod Skin grafts 吳郭魚/鱈魚皮移植 |
| After debridement phase on healthy granulation tissue to stimulate epithelialization 在清創階段後於健康肉芽組織上刺激上皮形成 |
| ||
| Must be used on clean wound 必須用於清潔傷口 | |
| Low-level laser 低強度雷射 |
| After inflammatory phase to encourage granulation tissue or epithelialization 於發炎期後使用以促進肉芽組織形成或上皮化 |
| Primary closed incisions 一期閉合切口 | |
| Photobiomodulation 光生物調節 |
| Primary closed incisions 一期閉合切口 |
| ||
| HBOT |
| During all phases of healing 在癒合過程的所有階段 |
| Best during the repair phase 在修復階段效果最佳 | |
| ||
| Primary closed incisions 一期閉合切口 | |
| ||
| Stem cells 幹細胞 |
| During all phases of healing 在癒合過程的所有階段 |
| Topical or Injections 局部或注射 | |
| ||
| ||
| Platelet-rich 富含血小板 |
| During all phases of healing 在癒合過程的所有階段 |
| Topicals or Injections 局部用藥或注射劑 | |
| ||
| ||
| ||
| ||
| Bioelectric 生物電 |
| After the inflammatory and debridement phase 在炎症和清創階段之後 |
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|
Negative pressure wound therapy
負壓傷口治療
NPWT has been used in veterinary patients successfully for many years, especially in the realm of traumatic wounds and oncologic reconstructions. An exhaustive discussion of the mechanism of action of NPWT is beyond the scope of this article but can be found in numerous other veterinary resources.2,30 Briefly, NPWT has 5 main effects which aid in wound healing:
負壓傷口治療(NPWT)在獸醫臨床已成功應用多年，特別是在創傷性傷口和腫瘤重建領域。本文不深入探討 NPWT 的作用機制(相關內容可參考其他獸醫文獻 2 30 )，簡要而言，NPWT 主要通過以下五種效應促進傷口癒合：
負壓傷口治療(NPWT)在獸醫臨床已成功應用多年，特別是在創傷性傷口和腫瘤重建領域。本文不深入探討 NPWT 的作用機制(相關內容可參考其他獸醫文獻 2 30 )，簡要而言，NPWT 主要通過以下五種效應促進傷口癒合：
- 1.withdraw wound exudate 引流傷口滲出液
- 2.improve the skins' elasticity by applying mechanical strain to bring edges together
通過施加機械應力改善皮膚彈性，使傷口邊緣靠攏 - 3.increase perfusion to the wound as far as 3 cm away from the foam31
增加傷口周圍 3 公分範圍內的灌注 31 - 4.reduce interstitial edema
減少間質水腫 - 5.and decrease the inflammatory response to injury by removing detrimental cytokines such as matrix metalloproteinases.
並通過清除有害細胞因子(如基質金屬蛋白酶)來降低對損傷的炎症反應
NPWT typically requires an open-cell polyurethane or polyvinyl alcohol foam to be placed within or over the surface of a wound. The active suction device is attached to this foam and effectively seals the wound under an occlusive bandage (Fig. 9). In some cases, specialized tubing attaches this bandage to a vacuum pump to allow for either continuous or intermittent suction to be applied to the wound. Based on earlier studies, a pressure of 125 mm Hg at a continuous rate is the most common method.
負壓傷口治療(NPWT)通常需要在傷口內或表面放置開孔聚氨酯或聚乙烯醇泡棉。主動抽吸裝置連接於此泡棉，並在密閉敷料下有效密封傷口(圖 9)。某些情況下，專用導管會將此敷料連接至真空泵，以便對傷口施加連續或間歇性負壓。根據早期研究，以 125 毫米汞柱壓力進行連續抽吸是最常用的方法。
Commonly found suction tubing attached to surgical suction units can and is also used and in the authors, experience affords excellent outcomes with less expense.32
手術用抽吸裝置常見的抽吸管亦可使用，根據作者經驗，這種方式不僅成本較低，還能獲得優異的治療效果。 32
負壓傷口治療(NPWT)通常需要在傷口內或表面放置開孔聚氨酯或聚乙烯醇泡棉。主動抽吸裝置連接於此泡棉，並在密閉敷料下有效密封傷口(圖 9)。某些情況下，專用導管會將此敷料連接至真空泵，以便對傷口施加連續或間歇性負壓。根據早期研究，以 125 毫米汞柱壓力進行連續抽吸是最常用的方法。
Commonly found suction tubing attached to surgical suction units can and is also used and in the authors, experience affords excellent outcomes with less expense.32
手術用抽吸裝置常見的抽吸管亦可使用，根據作者經驗，這種方式不僅成本較低，還能獲得優異的治療效果。 32
Fig. 9. Photograph of NPWT bandage applied to the lateral aspect of patient who sustained significant burns.
圖 9. 負壓傷口治療敷料應用於大面積燒傷患者側面的照片。
The clinical benefits of NPWT include reduced time to granulation tissue and healing compared with other topical dressings.30 In humans studies have shown an increase in blood supply and granulation tissue formation, and a reduction in bacterial load (most likely due to the hypoxic environment).33,34 NPWT has been used for open wounds, planned oncologic reconstructions (skin flaps or grafts) and incisional protection. One of the major benefits to NPWT is the reduction in required bandage changes for patients and clients and these bandages are typically well-tolerated by patients including cats and exotic animals when the pressure is at a continuous rate.
負壓傷口治療的臨床效益包括：與其他局部敷料相比，能縮短肉芽組織形成與傷口癒合時間。 30 人體研究顯示，此療法能增加血液供應與肉芽組織形成，並降低細菌負荷（很可能是因缺氧環境所致）。 33 34 該技術已應用於開放性傷口、計劃性腫瘤重建（皮瓣或移植）及切口保護。其主要優勢在於可減少患者與飼主更換敷料的頻率，且當壓力維持恆定時，包括貓科與特殊寵物在內的患者通常對這類敷料耐受性良好。
NPWT is most appropriate during the inflammatory and debridement phases of healing when exudate is expected. These bandages should be kept in place for 2 to 3 days at a time which eliminates daily or twice daily bandage changes that can be necessary during this time to avoid the maceration of tissues due to.35 While some veterinarians are able to send the vacuum units home with patients, other facilities do require hospitalization for NPWT management which can be considered a disadvantage. Application of an NPWT can be performed under moderate sedation if the wound has already been debrided or general anesthesia if surgical debridement is necessary. Table 5 reviews the steps of application with different options highlighted at each step.
負壓傷口治療(NPWT)最適合應用於預期會有滲出液的炎症期和清創期癒合階段。此類敷料應每次維持 2 至 3 天，可避免在此期間因頻繁更換敷料(每日或每日兩次)而導致組織浸漬。 35 雖然部分獸醫師能讓患者攜帶真空裝置回家治療，但其他機構仍要求住院進行負壓傷口治療管理，這可被視為一項缺點。若傷口已完成清創，可在中度鎮靜下實施負壓傷口治療；若需進行手術清創，則需全身麻醉。表 5 詳列了應用步驟，並在各步驟中標註不同選項。
負壓傷口治療的臨床效益包括：與其他局部敷料相比，能縮短肉芽組織形成與傷口癒合時間。 30 人體研究顯示，此療法能增加血液供應與肉芽組織形成，並降低細菌負荷（很可能是因缺氧環境所致）。 33 34 該技術已應用於開放性傷口、計劃性腫瘤重建（皮瓣或移植）及切口保護。其主要優勢在於可減少患者與飼主更換敷料的頻率，且當壓力維持恆定時，包括貓科與特殊寵物在內的患者通常對這類敷料耐受性良好。
NPWT is most appropriate during the inflammatory and debridement phases of healing when exudate is expected. These bandages should be kept in place for 2 to 3 days at a time which eliminates daily or twice daily bandage changes that can be necessary during this time to avoid the maceration of tissues due to.35 While some veterinarians are able to send the vacuum units home with patients, other facilities do require hospitalization for NPWT management which can be considered a disadvantage. Application of an NPWT can be performed under moderate sedation if the wound has already been debrided or general anesthesia if surgical debridement is necessary. Table 5 reviews the steps of application with different options highlighted at each step.
負壓傷口治療(NPWT)最適合應用於預期會有滲出液的炎症期和清創期癒合階段。此類敷料應每次維持 2 至 3 天，可避免在此期間因頻繁更換敷料(每日或每日兩次)而導致組織浸漬。 35 雖然部分獸醫師能讓患者攜帶真空裝置回家治療，但其他機構仍要求住院進行負壓傷口治療管理，這可被視為一項缺點。若傷口已完成清創，可在中度鎮靜下實施負壓傷口治療；若需進行手術清創，則需全身麻醉。表 5 詳列了應用步驟，並在各步驟中標註不同選項。
Table 5. Steps for Application of Negative Pressure Wound bandage.
表 5. 負壓傷口敷料應用步驟
| Step 步驟 | Guidelines 操作指南 | Tip 小技巧 |
|---|---|---|
| 1 | Prepare the skin and wound/flap/graft/incision: Make sure the surrounding skin in clipped, clean and dry. 準備皮膚與傷口/皮瓣/移植片/切口：確保周圍皮膚已剃毛、清潔且乾燥。 | Consider alcohol application to the edges for better adherence of the occlusive dressing 考慮使用酒精塗抹邊緣以增強密封敷料的附著力 |
| 2 | Cut foam to the desired shape/size and apply directly to the wound. Foam comes in standard or silver-impregnated for added antibacterial properties. 將泡棉裁剪至所需形狀/尺寸後直接敷於傷口。泡棉分為標準型與含銀離子型，後者具額外抗菌特性。 | You can place simple interrupted sutures (3–0 to 2–0 m onofilament nonabsorbable) or skin staples to the wound edge to secure the foam to the wound. 您可以使用簡單間斷縫合（3-0 至 2-0 單股不可吸收縫線）或皮膚釘書針固定傷口邊緣，以將泡棉固定於傷口上。 |
| 3 | Place the impermeable dressing over the foam and cut a hole to attached specialized disc/tubing. 將防水敷料覆蓋於泡棉上，並剪出一個孔洞以連接專用圓盤/管路。 | Alternative 1: Place specialized disc/tubing directly on the foam and then place the impermeable dressing over and around the tubing for extra security. 替代方案 1：將專用圓盤/管路直接放置於泡棉上，然後將防水敷料覆蓋並圍繞管路以增加穩固性。 Alternative 2: Place a red rubber catheter into the foam through a small incision and place impermeable dressing over and around the catheter. 替代方案 2：將紅色橡膠導管通過小切口插入泡棉中，並將防水敷料覆蓋並圍繞導管。 |
| 4 | Attach the tubing to the vacuum and set pressure. Watch for characteristic contraction of the foam and listen for any leaks. 將管路連接至真空裝置並設定壓力。觀察泡沫的特徵性收縮情況，並注意聆聽是否有任何漏氣聲。 | Have additional strips impermeable dressing available to seal any leaks once vacuum pressure applied. 準備額外的防水敷料條帶，以便在施加真空壓力後密封任何漏氣處。 |
| 5 | If desired, place additional soft padded bandage for patient comfort and security of the vacuum tubing. 可視需要放置額外的軟墊繃帶，以增加患者舒適度並固定真空管路。 | Consider creating a window to assess the foam frequently for evidence of loss of pressure. 建議開設觀察窗，以便頻繁評估泡沫狀態，確認是否有壓力流失的跡象。 |
Recent Investigations 最新研究
Silver impregnated foam is available for use with and without NPWT devices and may decrease bacterial load and maceration of the peri-wound tissue.36 A prospective randomized control trial by Nolff and colleagues reported on the outcomes of 26 clinical dogs treated with NPWT compared with a polyurethane silver-impregnated foam dressing.37 In this study, dogs were matched by the underlying cause of wound, duration of wound presence, wound size, location, time to closure, bacterial load, and complications.
含銀泡棉敷料可搭配或不搭配負壓傷口治療(NPWT)裝置使用，能有效降低細菌負荷量並減少傷口周圍組織浸潤。 36 Nolff 等人進行的一項前瞻性隨機對照試驗，比較了 26 隻臨床病犬使用 NPWT 治療與聚氨酯含銀泡棉敷料的治療效果。 37 本研究根據傷口成因、存在時間、大小、位置、癒合時間、細菌負荷量及併發症等條件進行犬隻配對。
Total time to closure was significantly shorter (14.2 days vs 28.6 days), wound size decreased significantly and there was less progression of infection in the NPWT group compared with the silver-impregnated foam group.
相較於含銀泡棉組，NPWT 組的總癒合時間顯著縮短(14.2 天 vs 28.6 天)，傷口面積明顯減小，且感染惡化情況較少。
The effective control of local infection in the NPWT was the most important factor associated with a decreased complication rate and an overall decreased cost for this group when compared with the silver-impregnated foam group. While the local effects of NPWT on bacterial load are controversial,38 a study looking at the effects on antibiotic tissue or plasma concentrations under vacuum pressure in an experimental model did not illustrate a benefit.39
負壓傷口治療（NPWT）中有效控制局部感染是與降低併發症發生率及整體治療成本最相關的重要因素，相較於使用含銀敷料泡沫的對照組。雖然 NPWT 對細菌負荷的局部影響仍存在爭議， 38 但一項針對真空壓力下抗生素組織/血漿濃度變化的實驗模型研究並未顯示出顯著效益。 39
含銀泡棉敷料可搭配或不搭配負壓傷口治療(NPWT)裝置使用，能有效降低細菌負荷量並減少傷口周圍組織浸潤。 36 Nolff 等人進行的一項前瞻性隨機對照試驗，比較了 26 隻臨床病犬使用 NPWT 治療與聚氨酯含銀泡棉敷料的治療效果。 37 本研究根據傷口成因、存在時間、大小、位置、癒合時間、細菌負荷量及併發症等條件進行犬隻配對。
Total time to closure was significantly shorter (14.2 days vs 28.6 days), wound size decreased significantly and there was less progression of infection in the NPWT group compared with the silver-impregnated foam group.
相較於含銀泡棉組，NPWT 組的總癒合時間顯著縮短(14.2 天 vs 28.6 天)，傷口面積明顯減小，且感染惡化情況較少。
The effective control of local infection in the NPWT was the most important factor associated with a decreased complication rate and an overall decreased cost for this group when compared with the silver-impregnated foam group. While the local effects of NPWT on bacterial load are controversial,38 a study looking at the effects on antibiotic tissue or plasma concentrations under vacuum pressure in an experimental model did not illustrate a benefit.39
負壓傷口治療（NPWT）中有效控制局部感染是與降低併發症發生率及整體治療成本最相關的重要因素，相較於使用含銀敷料泡沫的對照組。雖然 NPWT 對細菌負荷的局部影響仍存在爭議， 38 但一項針對真空壓力下抗生素組織/血漿濃度變化的實驗模型研究並未顯示出顯著效益。 39
Incisional Negative Pressure Wound Therapy
切口負壓傷口治療
The benefits of NPWT for traumatic wounds and reconstructive surgeries such as skin grafts and flaps are well documented but studies investigating the use with primary closure procedures have also been reported.40 A case report in a dog with a history of chronic incisional complications and abscess formation reported the use of a commercially available device (Prevena, 3M + KCI) after debridement and primary closure. This patient was managed in a staged procedure with open NPWT after abscess removal for 2 days and then INPWT for 7 days after primary closure.41 A systematic review of the mechanism of action and outcomes of INPWT included 2 experimental prospective animal (pig) studies. Results reported a decrease of incisional infections, hematoma formation, and reoperation rates for human patients undergoing INPWT but data on dehiscence, skin necrosis, rehospitalization, and cost savings were inconclusive.
負壓傷口治療(NPWT)對於創傷性傷口及重建手術(如皮膚移植與皮瓣手術)的益處已有充分文獻記載，但針對其用於初期閉合手術的研究報告也陸續出現。 40 一份犬隻病例報告記載，該病例有慢性切口併發症與膿腫形成病史，在清創與初期閉合後使用市售設備(Prevena, 3M + KCI)進行治療。該病例採用分階段處理方式：膿腫清除後先進行 2 天開放式 NPWT，初期閉合後再實施 7 天切口負壓治療(INPWT)。 41 一份關於 INPWT 作用機制與治療結果的系統性文獻回顧包含 2 項前瞻性動物(豬)實驗研究。結果顯示接受 INPWT 的人類患者其切口感染率、血腫形成率與再次手術率均下降，但關於傷口裂開、皮膚壞死、再住院率及成本節省方面的數據則尚無明確結論。
負壓傷口治療(NPWT)對於創傷性傷口及重建手術(如皮膚移植與皮瓣手術)的益處已有充分文獻記載，但針對其用於初期閉合手術的研究報告也陸續出現。 40 一份犬隻病例報告記載，該病例有慢性切口併發症與膿腫形成病史，在清創與初期閉合後使用市售設備(Prevena, 3M + KCI)進行治療。該病例採用分階段處理方式：膿腫清除後先進行 2 天開放式 NPWT，初期閉合後再實施 7 天切口負壓治療(INPWT)。 41 一份關於 INPWT 作用機制與治療結果的系統性文獻回顧包含 2 項前瞻性動物(豬)實驗研究。結果顯示接受 INPWT 的人類患者其切口感染率、血腫形成率與再次手術率均下降，但關於傷口裂開、皮膚壞死、再住院率及成本節省方面的數據則尚無明確結論。
NPWT Without Foam or Gauze Dressing
無泡棉或紗布敷料的負壓傷口治療
NPWT is typically performed with filler dressings such as polyurethane and polyvinyl alcohol foams, or gauze as the contact layer. This layer is permeable allowing for airflow and suction to reach all areas of the wound, but tissue can grow into the material causing damage when it is removed, and fragments of the material can also break off becoming embedded. A recent study reported the development of a novel single-layer membrane dressing to deliver NPWT.42 In this experimental porcine study, the novel device decreased wound area, and inflammation and increased viable granulation tissue after 4 days of use. Clinical studies must be performed before recommendations for this device can be made.
負壓傷口治療(NPWT)通常使用聚氨酯和聚乙烯醇泡沫等填充敷料或紗布作為接觸層。這層敷料具有透氣性，可使氣流和抽吸作用到達傷口所有區域，但組織可能長入材料中，在移除時造成損傷，且材料碎片也可能脫落並殘留。最近一項研究報告開發出一種新型單層膜敷料用於實施 NPWT。 42 在這項豬隻實驗研究中，新型裝置在使用 4 天後減少了傷口面積和炎症反應，並增加了存活肉芽組織。在推薦使用此裝置前仍需進行臨床研究。
負壓傷口治療(NPWT)通常使用聚氨酯和聚乙烯醇泡沫等填充敷料或紗布作為接觸層。這層敷料具有透氣性，可使氣流和抽吸作用到達傷口所有區域，但組織可能長入材料中，在移除時造成損傷，且材料碎片也可能脫落並殘留。最近一項研究報告開發出一種新型單層膜敷料用於實施 NPWT。 42 在這項豬隻實驗研究中，新型裝置在使用 4 天後減少了傷口面積和炎症反應，並增加了存活肉芽組織。在推薦使用此裝置前仍需進行臨床研究。
Fish skin dressings: tilapia/cod
魚皮敷料：吳郭魚/鱈魚
One of the most promising treatments to be reported in few years is the use of fish skin grafts for the treatment of burns and other wounds (Fig. 10). First reported for the treatment of a burn in a pediatric patient, multiple randomized controlled studies have since been published describing multiple benefits.43, 44, 45, 46 In one study with 62 human burn patients randomized to tilapia skin graft dressing or conventional dressing with silver sulfadiazine cream 1%, faster re-epithelialization, reduced pain scores and therefore reduced pain medication administration and fewer bandage changes were required in the tilapia group.44 Morphologic studies on tilapia skin found many similarities to human skin (a deep dermis of thick organized collagen fibers arranged in similar orientation) but with a higher amount of type I collagen and a high tensile strength.47 One proposed mechanism of action of tilapia skin is the induction of epidermal growth factor and fibroblast growth factor expression from the tilapia collagen, stimulating the proliferation and differentiation of fibroblasts and keratinocytes.48 Peptides found in tilapia skin (piscidin 3 and 4) have also been shown to have antimicrobial activity.49,50 Another benefit to tilapia or fish skin is the excellent adherence it has to wound surfaces which allows for a moist environment and decreases the chance of bacterial colonization.46
近年來最具前景的治療方法之一是利用魚皮移植治療燒傷及其他創傷（圖 10）。首次報導應用於小兒燒傷患者治療後，已有數項隨機對照研究發表，闡述其多重效益 43,44,45,46。其中一項針對 62 名燒傷患者的研究顯示，相較於使用 1%磺胺嘧啶銀乳膏的傳統敷料組，採用吳郭魚皮移植敷料組展現出更快的上皮再生速度、較低的疼痛評分，從而減少止痛藥物使用頻率及更換敷料次數 44 。吳郭魚皮的形態學研究發現其與人類皮膚具有高度相似性（深層真皮由厚實且排列方向相似的膠原纖維組成），但含有更高比例的第一型膠原蛋白及優異的抗張強度 47 。研究推測吳郭魚皮的作用機制可能透過其膠原蛋白誘導表皮生長因子與纖維母細胞生長因子的表現，進而促進纖維母細胞與角質形成細胞的增殖分化。 48 研究顯示，羅非魚皮膚中發現的肽類（piscidin 3 和 4）具有抗菌活性。 49 50 羅非魚皮或魚皮的另一個優點是其對傷口表面的優異附著性，能維持濕潤環境並降低細菌定植的機會。 46
近年來最具前景的治療方法之一是利用魚皮移植治療燒傷及其他創傷（圖 10）。首次報導應用於小兒燒傷患者治療後，已有數項隨機對照研究發表，闡述其多重效益 43,44,45,46。其中一項針對 62 名燒傷患者的研究顯示，相較於使用 1%磺胺嘧啶銀乳膏的傳統敷料組，採用吳郭魚皮移植敷料組展現出更快的上皮再生速度、較低的疼痛評分，從而減少止痛藥物使用頻率及更換敷料次數 44 。吳郭魚皮的形態學研究發現其與人類皮膚具有高度相似性（深層真皮由厚實且排列方向相似的膠原纖維組成），但含有更高比例的第一型膠原蛋白及優異的抗張強度 47 。研究推測吳郭魚皮的作用機制可能透過其膠原蛋白誘導表皮生長因子與纖維母細胞生長因子的表現，進而促進纖維母細胞與角質形成細胞的增殖分化。 48 研究顯示，羅非魚皮膚中發現的肽類（piscidin 3 和 4）具有抗菌活性。 49 50 羅非魚皮或魚皮的另一個優點是其對傷口表面的優異附著性，能維持濕潤環境並降低細菌定植的機會。 46
Fig. 10. Photographs of tilapia skin applied to open wounds created by unknown trauma. (A) Large wound on dorsum and right lateral flank. (B) Smaller wounds on the right lateral thigh and thorax.
圖 10. 羅非魚皮應用於不明創傷造成開放性傷口的照片。(A) 背部及右側腹的大面積傷口。(B) 右側大腿及胸部的較小傷口。
The method for the application of tilapia grafts in veterinary medicine has not been published but based on human studies and the authors' experience using it steps are provided in Box 2 and Fig. 11. There have been multiple human studies reporting different sterilization and storage techniques for fish skin.45 The wound should not have active purulent or necrotic debris present at the time of graft placement. Specific preparation and sterilization techniques (glycerolization, irradiation) have been used in human studies on tilapia skin grafts, but less stringent techniques have been anecdotally utilized in veterinary medicine. These fish grafts seem to have a noninfectious microbiota which may allow their successful use without irradiation but experimental and clinical studies in veterinary medicine need to be performed. No adverse effects from tilapia grafts have been reported in people or in animal studies to date and decreased cost and anxiety in patients and medical professionals due to fewer hospital visits and bandage changes mean this treatment may be very useful for wound management.
目前尚未發表將吳郭魚皮移植應用於獸醫學的具體方法，但根據人類研究及作者使用經驗，其操作步驟詳見方框 2 與圖 11。已有諸多人類研究報告了不同的魚皮滅菌與保存技術。 45 在進行移植時，傷口不應存在化膿性或壞死性組織碎片。人類針對吳郭魚皮移植的研究中採用特定製備與滅菌技術（甘油化處理、輻照滅菌），但在獸醫領域則有使用較寬鬆技術的臨床案例報告。這類魚皮移植物似乎具有非致病性微生物群落，可能使其在未經輻照處理下仍能成功使用，但尚需進行獸醫領域的實驗與臨床研究。迄今為止，人類或動物研究中均未報告吳郭魚皮移植相關不良反應，且因減少就診次數與換藥頻率所降低的治療成本與醫病雙方焦慮，顯示此療法在傷口照護上極具應用價值。
A study on the collagen hydrogels created from tilapia skin significantly accelerated wound healing in deep second degree burns in a mouse model.51
一項關於以羅非魚皮製成的膠原蛋白水凝膠研究顯示，其能顯著加速小鼠模型中深二度燒傷的傷口癒合。 51
目前尚未發表將吳郭魚皮移植應用於獸醫學的具體方法，但根據人類研究及作者使用經驗，其操作步驟詳見方框 2 與圖 11。已有諸多人類研究報告了不同的魚皮滅菌與保存技術。 45 在進行移植時，傷口不應存在化膿性或壞死性組織碎片。人類針對吳郭魚皮移植的研究中採用特定製備與滅菌技術（甘油化處理、輻照滅菌），但在獸醫領域則有使用較寬鬆技術的臨床案例報告。這類魚皮移植物似乎具有非致病性微生物群落，可能使其在未經輻照處理下仍能成功使用，但尚需進行獸醫領域的實驗與臨床研究。迄今為止，人類或動物研究中均未報告吳郭魚皮移植相關不良反應，且因減少就診次數與換藥頻率所降低的治療成本與醫病雙方焦慮，顯示此療法在傷口照護上極具應用價值。
A study on the collagen hydrogels created from tilapia skin significantly accelerated wound healing in deep second degree burns in a mouse model.51
一項關於以羅非魚皮製成的膠原蛋白水凝膠研究顯示，其能顯著加速小鼠模型中深二度燒傷的傷口癒合。 51
Box 2 方框 2
Steps for Application of Fish Skin to Wounds (Fig. 11)
魚皮敷料應用於傷口的步驟（圖 11）
魚皮敷料應用於傷口的步驟（圖 11）
- 1.Lavage and clean the wound to be treated. (No necrotic debris or active purulent exudate).
1. 沖洗並清潔待處理傷口（需無壞死組織碎片或活動性化膿性滲出液） - 2.Place sterile hydrogel or wound gel in a thin layer on the wound to ensure adherence to the fish skin graft.
在傷口上薄薄地塗抹一層無菌水凝膠或傷口凝膠，以確保與魚皮移植片緊密貼合。 - 3.Place more hydrogel over the fish skin graft to ensure moisture is retained.
在魚皮移植片上再塗抹更多水凝膠以保持濕潤。 - 4.Place absorbent hydrophilic foam or gauze over the fish skin graft and then cover with a soft padded bandage.
在魚皮移植片上覆蓋吸水性親水泡棉或紗布，然後用柔軟的加墊繃帶包紮。 - 5.Check bandage every 2 to 3 days. If excessive exudate is present, remove graft, cleanse and reapply new graft. If graft well-adhered and minimal exudate present at foam/gauze, reapply hydrogel over graft and new absorbent layer (foam/gauze) and rebandage.
每 2 至 3 天檢查一次繃帶。若出現過多滲出液，需移除移植片、清潔傷口並重新敷上新移植片。若移植片貼合良好且泡棉/紗布上僅有少量滲出液，則在移植片上重新塗抹水凝膠並更換新的吸收層（泡棉/紗布）後重新包紮。 - 6.To remove fish skin to evaluate wound/skin below saline or tap water can be used to gently break down material. Petrolatum jelly can also be used to loosen the graft from the wound/skin.
若要移除魚皮以評估下方傷口/皮膚狀況，可使用生理食鹽水或自來水輕柔分解材質。凡士林也可用於鬆動移植皮片與傷口/皮膚的黏著。
Fig. 11. Photographs of tilapia fish skin graft application. (A) Dorsum wound after debridement with NPWT in preparation for tilapia graft. (B) Application of thawed tilapia grafts. The grafts were sutured to the edges and sterile hydrogel was applied to keep them moist. (C) Tie over bandage applied with the layer of hydrophilic foam and a nonpermeable layer.
圖 11. 吳郭魚魚皮移植應用照片。(A) 清創後背部傷口使用負壓傷口治療(NPWT)準備進行魚皮移植。(B) 解凍後吳郭魚皮移植片應用。移植片縫合至邊緣並使用無菌水凝膠保持濕潤。(C) 施加覆蓋式繃帶，包含親水性泡棉層與不透水層。
(照片由 Rosselli 醫師提供)
North Atlantic cod skin grafts (Kerecis) have also been reported to speed epithelialization in multiple human studies.52,53 One prospective double-blind biopsy wound study compared these grafts to human amnionic/chorionic membrane dressings and found faster healing time with no difference in local inflammation or irritation.53 These commercially available dressings have the benefit of being freeze-dried with a shelf life of 3 years. The advantages of these dressings according to earlier studies include the retention of Omega 3 fatty acids which have been shown to create a bacterial barrier and pain-modulating effects.53 As more clinicians gain experience with these products future research needs to investigate the safety and efficacy of these grafts in veterinary medicine.
北大西洋鱈魚皮移植（Kerecis）在多人體研究中已被證實能加速上皮形成。 52 53 一項前瞻性雙盲活檢傷口研究將此類移植與人類羊膜/絨毛膜敷料進行比較，發現其癒合時間更快，且局部發炎或刺激反應無差異。 53 這類市售敷料的優勢在於經過冷凍乾燥處理，保存期限可達 3 年。根據早期研究，這些敷料的優點包括保留了 Omega-3 脂肪酸，經證實能形成細菌屏障並具有疼痛調節作用。 53 隨著更多臨床醫師累積使用經驗，未來研究需探討此類移植在獸醫領域的安全性與療效。
北大西洋鱈魚皮移植（Kerecis）在多人體研究中已被證實能加速上皮形成。 52 53 一項前瞻性雙盲活檢傷口研究將此類移植與人類羊膜/絨毛膜敷料進行比較，發現其癒合時間更快，且局部發炎或刺激反應無差異。 53 這類市售敷料的優勢在於經過冷凍乾燥處理，保存期限可達 3 年。根據早期研究，這些敷料的優點包括保留了 Omega-3 脂肪酸，經證實能形成細菌屏障並具有疼痛調節作用。 53 隨著更多臨床醫師累積使用經驗，未來研究需探討此類移植在獸醫領域的安全性與療效。
Low-level laser 低強度雷射
Low-level laser therapy (LLLT) or cold laser therapy is considered any device which emits less than 10W of power when applied to the tissue. The use of these devices for accelerating wound healing has been investigated but the exact mechanism behind the cellular modulation is unknown.54 A proposed mechanism posits photon activation of cytochrome oxidase leading to energy production and synthesis of proteins involved in cellular repair. Other possibilities include possible effects of the radiation on cellular differentiation and prostaglandin synthesis.55,56 There are wide disparities in the literature regarding the effects of LLLT for wound healing as the reports use varied machines, treatments, and outcome measures. There are differences between available commercial devices in laser class (I–IV), wavelength, and the energy density they can administer as well.
低強度雷射治療（LLLT）或冷雷射治療是指任何施加於組織時功率低於 10W 的裝置。雖然已有研究探討這些裝置用於加速傷口癒合的效果，但其影響細胞調節的確切機制仍屬未知。 54 一種假設機制認為光子會活化細胞色素氧化酶，從而促進能量產生及參與細胞修復的蛋白質合成。其他可能性包括輻射可能對細胞分化及前列腺素合成產生的影響。 55 56 由於文獻中使用的機器、治療方式和結果評估指標各異，關於 LLLT 對傷口癒合效果的報告存在很大差異。市售設備在雷射等級（I–IV 類）、波長及可施予的能量密度方面也有所不同。
The most commonly used wavelength in studies of LLLT that has shown improvement in wound healing is 635 nm (helium–neon) but an experimental randomized study using a class II He–Ne laser 3 times a week failed to show a benefit in an acute canine wound model over a 21 day period.54
在 LLLT 研究中，最常使用且顯示能改善傷口癒合的波長為 635 奈米（氦氖雷射），但一項使用 II 類氦氖雷射每週 3 次的實驗性隨機研究顯示，在 21 天的急性犬隻傷口模型中並未觀察到顯著效益。 54
低強度雷射治療（LLLT）或冷雷射治療是指任何施加於組織時功率低於 10W 的裝置。雖然已有研究探討這些裝置用於加速傷口癒合的效果，但其影響細胞調節的確切機制仍屬未知。 54 一種假設機制認為光子會活化細胞色素氧化酶，從而促進能量產生及參與細胞修復的蛋白質合成。其他可能性包括輻射可能對細胞分化及前列腺素合成產生的影響。 55 56 由於文獻中使用的機器、治療方式和結果評估指標各異，關於 LLLT 對傷口癒合效果的報告存在很大差異。市售設備在雷射等級（I–IV 類）、波長及可施予的能量密度方面也有所不同。
The most commonly used wavelength in studies of LLLT that has shown improvement in wound healing is 635 nm (helium–neon) but an experimental randomized study using a class II He–Ne laser 3 times a week failed to show a benefit in an acute canine wound model over a 21 day period.54
在 LLLT 研究中，最常使用且顯示能改善傷口癒合的波長為 635 奈米（氦氖雷射），但一項使用 II 類氦氖雷射每週 3 次的實驗性隨機研究顯示，在 21 天的急性犬隻傷口模型中並未觀察到顯著效益。 54
A more recent experimental study in dogs prospectively created open and closed wounds that were treated with and without LLLT.57 This study looked at bilateral flank ovariectomy incisions and bilateral open wounds created by a dermal punch in 10 healthy dogs. The treated sides received LLLT with a class IV laser (980 nm) once daily for 5 days. This study also failed to illustrate the effect of LLLT on the subjective wound healing assessment or wound measurements; however, the control group did have more necrosis and perivascular inflammation on day 7.
最近一項針對犬隻的實驗研究前瞻性地建立了開放性和閉合性傷口，並分別施以低能量雷射治療(LLLT)與未治療的對照組。 57 該研究在 10 隻健康犬隻的雙側腹脅部卵巢切除術切口處及雙側以皮膚打孔器製造的開放性傷口進行觀察。治療側每日接受一次 980 奈米第四級雷射的 LLLT 治療，持續 5 天。此研究同樣未能證實 LLLT 對主觀傷口癒合評估或傷口測量值的影響；然而對照組在第 7 天確實出現較多的壞死及血管周圍炎症反應。
An in vitro study on the effect of a class IV laser (helium–neon) on the cellular migration and proliferation of cultured canine keratinocytes did show a positive effect.58 The lack of standardization of wavelength, energy density, and treatment regularity hinder a definitive answer regarding this modality of wound therapy. Future research must be performed to validate the use of LLLT in a clinical setting.
一項關於氦氖第四級雷射對培養犬角質細胞遷移與增殖影響的體外研究確實顯示了正面效果。 58 由於波長、能量密度及治療頻率缺乏標準化，使得這種傷口治療方式的確切效果仍無定論。未來需要進行更多研究來驗證 LLLT 在臨床應用上的價值。
最近一項針對犬隻的實驗研究前瞻性地建立了開放性和閉合性傷口，並分別施以低能量雷射治療(LLLT)與未治療的對照組。 57 該研究在 10 隻健康犬隻的雙側腹脅部卵巢切除術切口處及雙側以皮膚打孔器製造的開放性傷口進行觀察。治療側每日接受一次 980 奈米第四級雷射的 LLLT 治療，持續 5 天。此研究同樣未能證實 LLLT 對主觀傷口癒合評估或傷口測量值的影響；然而對照組在第 7 天確實出現較多的壞死及血管周圍炎症反應。
An in vitro study on the effect of a class IV laser (helium–neon) on the cellular migration and proliferation of cultured canine keratinocytes did show a positive effect.58 The lack of standardization of wavelength, energy density, and treatment regularity hinder a definitive answer regarding this modality of wound therapy. Future research must be performed to validate the use of LLLT in a clinical setting.
一項關於氦氖第四級雷射對培養犬角質細胞遷移與增殖影響的體外研究確實顯示了正面效果。 58 由於波長、能量密度及治療頻率缺乏標準化，使得這種傷口治療方式的確切效果仍無定論。未來需要進行更多研究來驗證 LLLT 在臨床應用上的價值。
Photobiomodulation 光生物調節
A recent addition to the long list of treatments used in veterinary medicine for wound healing is photobiomodulation (PBM) devices which consist of light-emitting devices (LED) that reportedly stimulate cellular transduction pathways. Biological processes are stimulated through the activation of photoacceptors present in many different cell types and tissues. A specific type of PBM called fluorescence photobiomodulation (FPBM) has recently been studied in veterinary medicine.59 With FPBM, light-absorbing molecules convert the light emitted by the device to broader wavelengths and lower energy which in turn is reported to penetrate the skin and encourage healing.60,61 When the chromophores in the topical photoconverter (gel) are activated by the LED light source, they release photons at varying wavelengths in the form of fluorescence.
獸醫醫學用於傷口癒合的眾多治療方法中，近期新增了光生物調節（PBM）裝置，這類由發光二極體（LED）組成的設備據稱能刺激細胞轉導路徑。透過活化多種不同細胞類型與組織中存在的光受體，可刺激生物學過程。獸醫領域近期研究了一種特定類型的光生物調節——螢光光生物調節（FPBM）。 59 FPBM 技術中，吸光分子會將裝置發出的光轉換為更寬波長和更低能量，據報導這種轉換後的光線能穿透皮膚並促進癒合。 60 61 當局部光轉換劑（凝膠）中的發色團被 LED 光源激活時，會以螢光形式釋放出不同波長的光子。
獸醫醫學用於傷口癒合的眾多治療方法中，近期新增了光生物調節（PBM）裝置，這類由發光二極體（LED）組成的設備據稱能刺激細胞轉導路徑。透過活化多種不同細胞類型與組織中存在的光受體，可刺激生物學過程。獸醫領域近期研究了一種特定類型的光生物調節——螢光光生物調節（FPBM）。 59 FPBM 技術中，吸光分子會將裝置發出的光轉換為更寬波長和更低能量，據報導這種轉換後的光線能穿透皮膚並促進癒合。 60 61 當局部光轉換劑（凝膠）中的發色團被 LED 光源激活時，會以螢光形式釋放出不同波長的光子。
In the study by Salvaggio and colleagues, a novel FPBM device comprised of a blue LED light and a carbopol-based amorphous hydrogel was used in a prospective blinded controlled clinical trial. Ten healthy dogs undergoing orthopedic procedures were enrolled and half of the length of their incisions was treated with the FPBM device, and the other half acted as an internal control.
在 Salvaggio 及其同事的研究中，一項前瞻性盲法對照臨床試驗使用了由藍光 LED 燈和卡波姆基無定形水凝膠組成的新型 FPBM 裝置。研究納入了十隻接受骨科手術的健康犬隻，其切口長度的一半使用 FPBM 裝置進行治療，另一半則作為內部對照組。
The incisions were treated with the Phovia device (KT-V lamp; Klox Technologies, Laval, Quebec, Canada) for 2 minutes on the first postoperative day and every 3 days after that until day 13. This device delivers a blue light with wavelengths between 440 and 460 nm and a power density ranging between 55 and 129 mW/cm2. Biopsies performed from each section of the healed incisions on day 13 revealed less inflammation of the dermal layer, complete re-epithelialization, and a larger amount of collagen in the Phovia treated section. No adverse reactions were reported to the photoconverter gel. While other studies have looked at PBM treatments for pyoderma and otitis62,63 this is the first to look at wound healing. Future studies will need to address the ability of this technology to improve open traumatic and chronic wounds.
切口在術後第一天使用 Phovia 設備（KT-V 燈；Klox Technologies，加拿大魁北克拉瓦爾）進行 2 分鐘治療，之後每 3 天治療一次直至第 13 天。該設備發射波長介於 440 至 460 nm 的藍光，功率密度範圍為 55 至 129 mW/cm²。第 13 天從各癒合切口部位採集的活檢顯示，經 Phovia 治療的區域真皮層炎症較輕、完全再上皮化且膠原蛋白含量更高。未報告光轉換凝膠產生不良反應。雖然其他研究已探討過 PBM 治療膿皮症和耳炎[1][2]，但這是首項針對傷口癒合的研究。未來研究需評估此技術對開放性創傷和慢性傷口的改善效果。
在 Salvaggio 及其同事的研究中，一項前瞻性盲法對照臨床試驗使用了由藍光 LED 燈和卡波姆基無定形水凝膠組成的新型 FPBM 裝置。研究納入了十隻接受骨科手術的健康犬隻，其切口長度的一半使用 FPBM 裝置進行治療，另一半則作為內部對照組。
The incisions were treated with the Phovia device (KT-V lamp; Klox Technologies, Laval, Quebec, Canada) for 2 minutes on the first postoperative day and every 3 days after that until day 13. This device delivers a blue light with wavelengths between 440 and 460 nm and a power density ranging between 55 and 129 mW/cm2. Biopsies performed from each section of the healed incisions on day 13 revealed less inflammation of the dermal layer, complete re-epithelialization, and a larger amount of collagen in the Phovia treated section. No adverse reactions were reported to the photoconverter gel. While other studies have looked at PBM treatments for pyoderma and otitis62,63 this is the first to look at wound healing. Future studies will need to address the ability of this technology to improve open traumatic and chronic wounds.
切口在術後第一天使用 Phovia 設備（KT-V 燈；Klox Technologies，加拿大魁北克拉瓦爾）進行 2 分鐘治療，之後每 3 天治療一次直至第 13 天。該設備發射波長介於 440 至 460 nm 的藍光，功率密度範圍為 55 至 129 mW/cm²。第 13 天從各癒合切口部位採集的活檢顯示，經 Phovia 治療的區域真皮層炎症較輕、完全再上皮化且膠原蛋白含量更高。未報告光轉換凝膠產生不良反應。雖然其他研究已探討過 PBM 治療膿皮症和耳炎[1][2]，但這是首項針對傷口癒合的研究。未來研究需評估此技術對開放性創傷和慢性傷口的改善效果。
Hyperbaric oxygen therapy
高壓氧治療
HBOT necessitates the patient to breath 100% oxygen at an atmospheric pressure greater than 1 atm absolute (ATA) in an airtight room. By inhaling pure oxygen in this environment, the dissolved oxygen in the bloodstream is reported to be up to 15 times that of normal room air (Fio2 21%). This treatment has been touted for a wide variety of diseases according to the Undersea and Hyperbaric Medical Society but recently several studies have attempted to prospectively investigate its safety and use in veterinary medicine (Fig. 12).64, 65, 66, 67, 68 A recent clinical trial of 78 dogs and 12 cats suffering from neurologic, gastrointestinal, hemopoietic, cardiorespiratory and integumentary diseases reported a 33% (76/230) rate of minor adverse effects including head shaking, panting, and swallowing but no major adverse effects associated with HBOT.65 No comments could be made regarding HBOTs efficacy in this population. The proposed mechanisms of the action of HBOT in these diseases include but are not limited to improving oxygen-carrying capacity in the plasma, increasing tissue oxygen perfusion, barometric effects, immunomodulation, and antioxidant effects. The increase in oxygen perfusion is especially helpful in wounds as it is reported to produce antibacterial effects, increase angiogenesis and growth factor synthesis, and decreases interstitial edema according to different human and animal model studies.
高壓氧治療（HBOT）需要患者在密閉艙室內，於超過 1 個絕對大氣壓（ATA）的環境下呼吸 100%純氧。據報導，在此環境中吸入純氧時，血液中溶解的氧氣量可達正常室內空氣（FiO₂ 21%）的 15 倍之多。根據海底與高壓醫學會指出，此療法被宣稱可應用於多種疾病，但近期數項研究嘗試前瞻性探討其在獸醫領域的安全性與應用（圖 12）。64,65,66,67,68 一項針對 78 隻犬與 12 隻貓的臨床試驗顯示，在患有神經系統、胃腸道、造血系統、心肺系統及體被系統疾病的病例中，有 33%（76/230）出現輕微副作用（包括搖頭、喘氣及吞嚥動作），但未發現與 HBOT 相關的重大不良反應。 65 關於 HBOT 對此類病患的療效尚無法得出結論。HBOT 作用於這些疾病的可能機制包括（但不限於）：提升血漿攜氧能力、增加組織氧合灌注、氣壓效應、免疫調節作用及抗氧化效應。 氧氣灌注的增加對傷口特別有益，根據不同的人體和動物模型研究顯示，這能產生抗菌效果、促進血管新生和生長因子合成，並減少間質性水腫。
高壓氧治療（HBOT）需要患者在密閉艙室內，於超過 1 個絕對大氣壓（ATA）的環境下呼吸 100%純氧。據報導，在此環境中吸入純氧時，血液中溶解的氧氣量可達正常室內空氣（FiO₂ 21%）的 15 倍之多。根據海底與高壓醫學會指出，此療法被宣稱可應用於多種疾病，但近期數項研究嘗試前瞻性探討其在獸醫領域的安全性與應用（圖 12）。64,65,66,67,68 一項針對 78 隻犬與 12 隻貓的臨床試驗顯示，在患有神經系統、胃腸道、造血系統、心肺系統及體被系統疾病的病例中，有 33%（76/230）出現輕微副作用（包括搖頭、喘氣及吞嚥動作），但未發現與 HBOT 相關的重大不良反應。 65 關於 HBOT 對此類病患的療效尚無法得出結論。HBOT 作用於這些疾病的可能機制包括（但不限於）：提升血漿攜氧能力、增加組織氧合灌注、氣壓效應、免疫調節作用及抗氧化效應。 氧氣灌注的增加對傷口特別有益，根據不同的人體和動物模型研究顯示，這能產生抗菌效果、促進血管新生和生長因子合成，並減少間質性水腫。
Fig. 12. (HBOT pics Jake, Sissy): Photographs of patients within a hyperbaric oxygen chamber. (A) Patient suffering from multiple wounds after being drug behind a truck accident. HBOT was used in this case due to questionable healing and severe edema all over the body. (B) Patient sustained a 360° slough of the antebrachium after tumor removal and closure with tourniquet effect. HBOT was used to maximize all chances for healing to avoid amputation and for potential improvement in antibiotic penetration due to ongoing infection. Most patients tolerate the chamber well with light sedation or pain medication administration.
圖 12.（HBOT 照片 Jake、Sissy）：高壓氧艙內患者的照片。（A）患者在卡車事故中被拖行後遭受多處傷口。由於癒合情況不確定且全身嚴重水腫，此病例採用了高壓氧治療。（B）患者在腫瘤切除後前臂出現 360 度腐肉脫落，並因止血帶效應導致傷口閉合不良。採用高壓氧治療是為了最大化癒合機會以避免截肢，並因持續感染而可能改善抗生素滲透。多數患者在輕度鎮靜或止痛藥輔助下都能良好耐受艙內治療。
（照片由 Lux 醫師提供）
A thorough review on the scientific basis, proposed physiologic mechanisms and possible clinical indications in veterinary wound and trauma patients has been published recently.66 The varied case reports and retrospective series highlighted in this review and elsewhere are interesting but controlled data objectively comparing outcomes in patients are lacking. A prospective controlled study on HBOT in dogs compared daily HBOT treatments for 7 days after controlled wounds and incisions were created.67 No differences were seen between control and HBOT groups with regards to wound contraction, epithelialization, subjective wound assessment, histopathology, or culture results. A new area of research is lower pressure lower oxygen hyperbaric treatments (1500 hPa pressure and 26% oxygen concentration in the chamber). A clinical study of 6 dogs compared with 6 controls undergoing hemimastectomy reported subjectively faster healing and fewer complications in dogs treated for 5 consecutive days after surgery.68 Future research should focus on randomized controlled trials with standardized methodologies to better characterize the true effects of HBOT on clinical patients.
近期已發表一篇關於獸醫傷口與創傷病患的科學基礎、生理機制假說及可能臨床適應症的全面性文獻回顧。 66 本回顧及相關文獻中強調的各種病例報告與回溯性研究雖具參考價值，但缺乏客觀比較病患預後的對照數據。一項針對犬隻高壓氧治療(HBOT)的前瞻性對照研究顯示，在建立控制性傷口與切口後連續 7 天每日進行 HBOT 治療。 67 在傷口收縮、上皮形成、主觀傷口評估、組織病理學或培養結果方面，對照組與 HBOT 組未見顯著差異。新興研究領域聚焦於低壓低氧的高壓治療（艙壓 1500 hPa，氧氣濃度 26%）。一項臨床研究比較 6 隻接受半乳腺切除術的治療犬與 6 隻對照犬，結果顯示術後連續治療 5 天的犬隻主觀上癒合更快且併發症較少。 68 未來研究應著重採用標準化方法的隨機對照試驗，以更準確評估 HBOT 對臨床病患的實際療效。
近期已發表一篇關於獸醫傷口與創傷病患的科學基礎、生理機制假說及可能臨床適應症的全面性文獻回顧。 66 本回顧及相關文獻中強調的各種病例報告與回溯性研究雖具參考價值，但缺乏客觀比較病患預後的對照數據。一項針對犬隻高壓氧治療(HBOT)的前瞻性對照研究顯示，在建立控制性傷口與切口後連續 7 天每日進行 HBOT 治療。 67 在傷口收縮、上皮形成、主觀傷口評估、組織病理學或培養結果方面，對照組與 HBOT 組未見顯著差異。新興研究領域聚焦於低壓低氧的高壓治療（艙壓 1500 hPa，氧氣濃度 26%）。一項臨床研究比較 6 隻接受半乳腺切除術的治療犬與 6 隻對照犬，結果顯示術後連續治療 5 天的犬隻主觀上癒合更快且併發症較少。 68 未來研究應著重採用標準化方法的隨機對照試驗，以更準確評估 HBOT 對臨床病患的實際療效。
Regenerative medicine techniques
再生醫學技術
Mesenchymal Stem Cells 間質幹細胞
Mesenchymal stem cell (MSC) therapy has been the focus of in vitro and in vivo research in both human and veterinary medicine for decades. The proposed benefits to these cells center on their ability to proliferate and differentiate into different cell lines, their antiinflammatory and pain-modulating properties, and immunomodulation. As with much of the data on the other treatments discussed in this chapter, MSC research in veterinary medicine was historically plagued by inconsistent methodologies between studies and anecdotal evidence.69, 70, 71, 72 Recently, however, there have been studies on the safety and efficacy of MSC's on wound healing in dogs.73,74 One study by Encisco and colleagues, in 24 dogs with acute and chronic wounds compared conventional wound therapy to intradermal (3 × 107 allogeneic adipose MSC in phosphate-buffered saline) and intra-wound (3 × 107 allogeneic adipose MSC in phosphate-buffered saline) injections.74 Patients received 2 injection treatments 7 days apart as well antibiotics during treatment. The control group had a neomycin/pennywort ointment applied as their wound treatment until healed. Wound size and epithelialization were measured at 7, 30, 90 days postinitiation of treatment and biopsies were performed on day 7 for histologic assessment and gene expression. Serum was also surveyed for both treatment and control patients on days 7 and 30 for cytokine secretion as an indication of an adverse event. Results of this study revealed improved epithelialization at 90 days of the MSC treated wounds, reduced inflammation, and the presence of hair follicles at 7 days in the MSC treated group, upregulation of genes relating to GM-CSF, and appropriate safety as evidenced by the lack of cytokine response.
間質幹細胞（MSC）療法數十年來一直是人類與獸醫學領域體外及體內研究的焦點。這些細胞的優勢在於其增殖與分化成不同細胞系的能力、抗發炎與疼痛調節特性，以及免疫調節作用。與本章討論的其他治療方式多數數據類似，獸醫學中的 MSC 研究長期存在研究方法不一致與個案報告的問題。69,70,71,72 然而近期已有針對犬隻傷口癒合中 MSC 安全性與療效的研究。 73 74 Encisco 及其團隊一項針對 24 隻急性與慢性傷口犬隻的研究，比較了傳統傷口治療與真皮內注射（3×10 7 同種異體脂肪來源 MSC 磷酸鹽緩衝液）及傷口內注射（3×10 7 同種異體脂肪來源 MSC 磷酸鹽緩衝液）。 74 患者接受間隔 7 天的兩次注射治療，期間配合抗生素使用。對照組則使用新黴素/積雪草軟膏作為傷口治療直至癒合。 在治療開始後的第 7、30、90 天測量傷口大小與上皮形成情況，並於第 7 天進行活組織檢查以評估組織學與基因表現。同時在第 7 天與第 30 天檢測治療組與對照組患者的血清細胞激素分泌情況，作為不良事件指標。研究結果顯示：MSC 治療組在 90 天時呈現改善的上皮形成、炎症反應減輕，且在 7 天時就出現毛囊結構；GM-CSF 相關基因表現上調，且未引發細胞激素反應，證實其安全性。
間質幹細胞（MSC）療法數十年來一直是人類與獸醫學領域體外及體內研究的焦點。這些細胞的優勢在於其增殖與分化成不同細胞系的能力、抗發炎與疼痛調節特性，以及免疫調節作用。與本章討論的其他治療方式多數數據類似，獸醫學中的 MSC 研究長期存在研究方法不一致與個案報告的問題。69,70,71,72 然而近期已有針對犬隻傷口癒合中 MSC 安全性與療效的研究。 73 74 Encisco 及其團隊一項針對 24 隻急性與慢性傷口犬隻的研究，比較了傳統傷口治療與真皮內注射（3×10 7 同種異體脂肪來源 MSC 磷酸鹽緩衝液）及傷口內注射（3×10 7 同種異體脂肪來源 MSC 磷酸鹽緩衝液）。 74 患者接受間隔 7 天的兩次注射治療，期間配合抗生素使用。對照組則使用新黴素/積雪草軟膏作為傷口治療直至癒合。 在治療開始後的第 7、30、90 天測量傷口大小與上皮形成情況，並於第 7 天進行活組織檢查以評估組織學與基因表現。同時在第 7 天與第 30 天檢測治療組與對照組患者的血清細胞激素分泌情況，作為不良事件指標。研究結果顯示：MSC 治療組在 90 天時呈現改善的上皮形成、炎症反應減輕，且在 7 天時就出現毛囊結構；GM-CSF 相關基因表現上調，且未引發細胞激素反應，證實其安全性。
Platelet-Rich Plasma 富含血小板血漿
Platelet-rich plasma (PRP) has also been investigated in both veterinary and human medicine as a treatment of a range of disease processes including wound healing. PRP is created by the centrifugation of whole blood in a double centrifugation tube/syringe device. Currently, there are no specific veterinary standards regarding the concentration of platelets, amount of white blood cells, or red blood cells allowed in each aliquot or treatment protocol. There are multiple companies with devices on the veterinary market (Arthrex, VetStem Biopharma, ReBound, and so forth) all with different cell preparation techniques.
富含血小板血漿（PRP）在獸醫和人類醫學中已被研究作為多種疾病過程的治療方法，包括傷口癒合。PRP 是通過使用雙重離心管/注射器裝置對全血進行離心而製備的。目前，對於每份樣本或治療方案中允許的血小板濃度、白血球數量或紅血球數量，尚無特定的獸醫標準。獸醫市場上有多家公司提供相關設備（如 Arthrex、VetStem Biopharma、ReBound 等），這些公司都採用不同的細胞製備技術。
PRP is known to contain cytokines and growth factors that stimulate fibroblast proliferation and migration, recruitment of mesenchymal cells, and extracellular matrix synthesis.75, 76, 77 There have also been studies displaying antimicrobial, anti-inflammatory, and pain-modulating properties to PRP.77,78 The literature has examples of both improved healing and no difference in the healing of wounds.76,79 The variation is most likely due to differences in PRP preparation, wound models, treatment protocols and outcome endpoints. The proposed advantages of PRP over other regenerative medicine treatments (MSC's) are the ease of collection and cost-effectiveness of treatment.
PRP 已知含有能刺激纖維母細胞增殖與遷移、募集間質細胞，以及促進細胞外基質合成的細胞激素與生長因子。75, 76, 77 研究亦顯示 PRP 具有抗菌、抗發炎及調節疼痛的特性。 77 78 文獻中既有顯示促進傷口癒合的案例，也有未見癒合差異的報告。 76 79 此差異很可能源自 PRP 製備方法、傷口模型、治療方案及評估終點的不同。相較於其他再生醫學療法（如間質幹細胞），PRP 的優勢在於採集簡便且具成本效益。
富含血小板血漿（PRP）在獸醫和人類醫學中已被研究作為多種疾病過程的治療方法，包括傷口癒合。PRP 是通過使用雙重離心管/注射器裝置對全血進行離心而製備的。目前，對於每份樣本或治療方案中允許的血小板濃度、白血球數量或紅血球數量，尚無特定的獸醫標準。獸醫市場上有多家公司提供相關設備（如 Arthrex、VetStem Biopharma、ReBound 等），這些公司都採用不同的細胞製備技術。
PRP is known to contain cytokines and growth factors that stimulate fibroblast proliferation and migration, recruitment of mesenchymal cells, and extracellular matrix synthesis.75, 76, 77 There have also been studies displaying antimicrobial, anti-inflammatory, and pain-modulating properties to PRP.77,78 The literature has examples of both improved healing and no difference in the healing of wounds.76,79 The variation is most likely due to differences in PRP preparation, wound models, treatment protocols and outcome endpoints. The proposed advantages of PRP over other regenerative medicine treatments (MSC's) are the ease of collection and cost-effectiveness of treatment.
PRP 已知含有能刺激纖維母細胞增殖與遷移、募集間質細胞，以及促進細胞外基質合成的細胞激素與生長因子。75, 76, 77 研究亦顯示 PRP 具有抗菌、抗發炎及調節疼痛的特性。 77 78 文獻中既有顯示促進傷口癒合的案例，也有未見癒合差異的報告。 76 79 此差異很可能源自 PRP 製備方法、傷口模型、治療方案及評估終點的不同。相較於其他再生醫學療法（如間質幹細胞），PRP 的優勢在於採集簡便且具成本效益。
Multiple experimental wound studies have been performed in veterinary medicine comparing the results of PRP injections or topical application to conventionally treated wounds in dogs.75, 76, 77, 78, 79 Iacopetti and colleagues, in 2020 reported increased epithelialization and contraction in 6 dogs undergoing 2 topical applications of PRP 15 days apart. While they saw no evidence of adverse effects, there was no control group and the wounds.76 An experimental study in 5 dogs in which 3 mLs of autologous PRP was injected subcutaneously in one of the 2 wounds created in each dog reported increased epithelialization in the treated wounds at 3 weeks and reduced scar tissue formation.77 A follow-up study from the same group also reported the results of weekly subcutaneous PRP injections in experimentally created MRSA infected wounds in dogs and found that the treatment wounds had quicker re-epithelialization, more contraction, had decreased bacterial load, and decreased reactive oxidant stress compared with controls.78
獸醫學領域已進行多項實驗性傷口研究，比較 PRP 注射或局部應用與傳統治療方式在犬隻傷口的成效。75, 76, 77, 78, 79 Iacopetti 及其團隊於 2020 年發表報告指出，6 隻接受兩次間隔 15 天的 PRP 局部應用的犬隻，其傷口上皮化和收縮程度有所提升。雖然未觀察到不良反應，但該研究缺乏對照組且傷口... 76 另一項針對 5 隻犬隻的實驗研究顯示，在每隻犬隻製造的兩處傷口中，其中一處皮下注射 3 毫升自體 PRP，結果發現治療組傷口在 3 週後上皮化程度提高且疤痕組織形成減少。 77 同一團隊的後續研究也報告了每週皮下注射 PRP 對實驗性 MRSA 感染犬隻傷口的療效，結果顯示相較對照組，治療組傷口具有更快的上皮再生速度、更明顯的傷口收縮、更低的細菌負荷以及減輕的氧化應激反應。 78
獸醫學領域已進行多項實驗性傷口研究，比較 PRP 注射或局部應用與傳統治療方式在犬隻傷口的成效。75, 76, 77, 78, 79 Iacopetti 及其團隊於 2020 年發表報告指出，6 隻接受兩次間隔 15 天的 PRP 局部應用的犬隻，其傷口上皮化和收縮程度有所提升。雖然未觀察到不良反應，但該研究缺乏對照組且傷口... 76 另一項針對 5 隻犬隻的實驗研究顯示，在每隻犬隻製造的兩處傷口中，其中一處皮下注射 3 毫升自體 PRP，結果發現治療組傷口在 3 週後上皮化程度提高且疤痕組織形成減少。 77 同一團隊的後續研究也報告了每週皮下注射 PRP 對實驗性 MRSA 感染犬隻傷口的療效，結果顯示相較對照組，治療組傷口具有更快的上皮再生速度、更明顯的傷口收縮、更低的細菌負荷以及減輕的氧化應激反應。 78
Bioelectric dressing 生物電敷料
Bioelectric dressings designed for use in human medicine for diabetic ulcers, pressure sores, and burn injuries have also been used in veterinary medicine for acute and chronic wounds. When skin is injured a change in the transepithelial resting electric potential occurs stimulating cell migration and re-epithelialization.80,81 Wound exudate provides the conduction medium for microcurrents (2–10 μA) created at the edges of the wound.82 Because this microcurrent only extends 1–2 mm from the wound edge, large wounds can take a long time to heal. The dressing (Fig. 13) reportedly mimics the physiologic currents created at wound edges by generating microcurrents on the wound surface when in the presence of a conductive medium. Physiologic benefits to this dressing have been reported to include: antibacterial properties,80, 81, 82, 83, 84 prevention of biofilm formation,85 optimization of the moist wound environment, and increases in keratinocyte migration (galvanotaxis)86 and epithelialization.87,88 Similar to NPWT and fish skin grafts, these dressings are maintained for longer periods of time as well, decreasing the cost and stress to owners and patients. One bioelectric dressing available to veterinary professionals is the Procellera Antimicrobial wound dressing (Vomaris, Tempe, AZ, USA) consisting of a polyester substrate with embedded elemental silver and zinc microcell batteries.
原本設計用於人類醫學治療糖尿病潰瘍、壓瘡和燒傷的生物電敷料，現也已應用於獸醫領域處理急慢性傷口。當皮膚受損時，跨上皮靜息電位會發生變化，進而刺激細胞遷移與上皮再生。 80 81 傷口滲出液可作為傳導介質，在傷口邊緣產生 2-10 微安的微電流。 82 由於此微電流僅能延伸至傷口邊緣 1-2 毫米範圍，大型傷口往往需要較長時間癒合。據報導，該敷料（圖 13）在導電介質存在時，能於傷口表面產生微電流，模擬傷口邊緣的生理電流。文獻指出此敷料具有多項生理效益，包括：抗菌特性 80, 81, 82, 83, 84、預防生物膜形成 85 、優化濕潤傷口環境，以及促進角質細胞遷移（趨電性） 86 與上皮化作用 87 88 。與負壓傷口治療和魚皮移植相似，這類敷料同樣可維持較長時間，有效降低飼主與病患的經濟負擔及心理壓力。 獸醫專業人員可使用的一種生物電敷料是 Procellera 抗菌傷口敷料（Vomaris 公司，美國亞利桑那州坦佩市），該敷料由聚酯基材製成，內嵌元素銀和鋅微型電池。
原本設計用於人類醫學治療糖尿病潰瘍、壓瘡和燒傷的生物電敷料，現也已應用於獸醫領域處理急慢性傷口。當皮膚受損時，跨上皮靜息電位會發生變化，進而刺激細胞遷移與上皮再生。 80 81 傷口滲出液可作為傳導介質，在傷口邊緣產生 2-10 微安的微電流。 82 由於此微電流僅能延伸至傷口邊緣 1-2 毫米範圍，大型傷口往往需要較長時間癒合。據報導，該敷料（圖 13）在導電介質存在時，能於傷口表面產生微電流，模擬傷口邊緣的生理電流。文獻指出此敷料具有多項生理效益，包括：抗菌特性 80, 81, 82, 83, 84、預防生物膜形成 85 、優化濕潤傷口環境，以及促進角質細胞遷移（趨電性） 86 與上皮化作用 87 88 。與負壓傷口治療和魚皮移植相似，這類敷料同樣可維持較長時間，有效降低飼主與病患的經濟負擔及心理壓力。 獸醫專業人員可使用的一種生物電敷料是 Procellera 抗菌傷口敷料（Vomaris 公司，美國亞利桑那州坦佩市），該敷料由聚酯基材製成，內嵌元素銀和鋅微型電池。
Fig. 13. (A) Photograph of commercially available bioelectric dressing with silver and zinc microbatteries embedded in a polyester backing. (B) Wound on flank fold before bioelectric dressing application. (C) Wound on flank fold after 4 days of bioelectric dressing. A considerable decrease in the width of the wound is seen and there is excessive granulation tissue at the edges which was debrided.
圖 13. (A) 市售生物電敷料照片，顯示聚酯背襯中嵌入的銀鋅微型電池。(B) 側腹皺褶處傷口在應用生物電敷料前的狀態。(C) 使用生物電敷料 4 天後的側腹皺褶處傷口。可見傷口寬度明顯縮小，邊緣出現過度增生的肉芽組織，已進行清創處理。
A literature review of the use, effect, and mechanisms of electrical stimulation in experimentally created cutaneous wounds in animals reported the potential for improved healing with direct current and bioelectric dressings.82 Some studies reviewed showed a variable effect with faster rates of re-epithelialization, increased wound collagen content and improved angiogenesis but other studies reported no improvement or even deleterious effects. Unsurprisingly, the methods, modality, and polarities in these experiments varied greatly.
一篇關於電刺激在動物實驗性皮膚傷口中應用、效果及機制的文獻回顧指出，直流電與生物電敷料具有促進傷口癒合的潛力。 82 部分研究顯示其能加速上皮再生、增加傷口膠原蛋白含量並改善血管新生，但其他研究則報告無顯著效果甚至出現負面影響。這些實驗在方法、模式與電極極性方面存在顯著差異，此結果並不令人意外。
A case series in 10 client-owned equine patients reported improved wound healing and cosmesis without excessive granulation tissue with the use of a bioelectric dressing.89 A recent case series in 4 dogs and 1 cat also reported positive clinical outcomes in patients with severe traumatic or complex wounds treated with a bioelectric dressing.83 The authors of this case series conclude the bioelectric dressing benefited wound healing in their case population by generating an electrical field at physiologic levels to induce galvanotaxis (thus improving re-epithelialization) and reduced the bacterial burden and potential for biofilm.
一份針對 10 匹客戶所有馬匹患者的病例系列研究報告指出，使用生物電敷料可改善傷口癒合與美觀效果，且未出現過度肉芽組織增生。 89 另一項近期針對 4 隻狗與 1 隻貓的病例系列研究也顯示，生物電敷料對嚴重創傷性或複雜傷口患者具有積極臨床效果。 83 該研究作者總結認為，生物電敷料通過產生生理級別的電場誘導趨電性（從而促進上皮再生），同時降低細菌負荷與生物膜形成風險，對其病例群的傷口癒合產生益處。
Neither of these clinical studies was prospective or randomized and neither included control groups. The author has used these dressings on chronic and infected wounds in clinical cases with success in her practice and anecdotally agrees that epithelialization seems to occur at a faster rate when the dressing is applied to healthy granulation tissue.
這兩項臨床研究皆非前瞻性亦非隨機對照試驗，且均未設置對照組。作者在臨床案例中曾成功將此敷料應用於慢性感染傷口，並根據實務經驗觀察到當敷料施用於健康肉芽組織時，上皮化進程似乎會加速。
The steps and tips used for the application of this dressing can be found in Box 3.
此敷料的具體操作步驟與技巧詳見方框 3。
一篇關於電刺激在動物實驗性皮膚傷口中應用、效果及機制的文獻回顧指出，直流電與生物電敷料具有促進傷口癒合的潛力。 82 部分研究顯示其能加速上皮再生、增加傷口膠原蛋白含量並改善血管新生，但其他研究則報告無顯著效果甚至出現負面影響。這些實驗在方法、模式與電極極性方面存在顯著差異，此結果並不令人意外。
A case series in 10 client-owned equine patients reported improved wound healing and cosmesis without excessive granulation tissue with the use of a bioelectric dressing.89 A recent case series in 4 dogs and 1 cat also reported positive clinical outcomes in patients with severe traumatic or complex wounds treated with a bioelectric dressing.83 The authors of this case series conclude the bioelectric dressing benefited wound healing in their case population by generating an electrical field at physiologic levels to induce galvanotaxis (thus improving re-epithelialization) and reduced the bacterial burden and potential for biofilm.
一份針對 10 匹客戶所有馬匹患者的病例系列研究報告指出，使用生物電敷料可改善傷口癒合與美觀效果，且未出現過度肉芽組織增生。 89 另一項近期針對 4 隻狗與 1 隻貓的病例系列研究也顯示，生物電敷料對嚴重創傷性或複雜傷口患者具有積極臨床效果。 83 該研究作者總結認為，生物電敷料通過產生生理級別的電場誘導趨電性（從而促進上皮再生），同時降低細菌負荷與生物膜形成風險，對其病例群的傷口癒合產生益處。
Neither of these clinical studies was prospective or randomized and neither included control groups. The author has used these dressings on chronic and infected wounds in clinical cases with success in her practice and anecdotally agrees that epithelialization seems to occur at a faster rate when the dressing is applied to healthy granulation tissue.
這兩項臨床研究皆非前瞻性亦非隨機對照試驗，且均未設置對照組。作者在臨床案例中曾成功將此敷料應用於慢性感染傷口，並根據實務經驗觀察到當敷料施用於健康肉芽組織時，上皮化進程似乎會加速。
The steps and tips used for the application of this dressing can be found in Box 3.
此敷料的具體操作步驟與技巧詳見方框 3。
Box 3 方框 3
Steps for Application of Bioelectric Dressing to Wounds
生物電敷料傷口應用步驟
生物電敷料傷口應用步驟
- 1.Clean and lavage wound as required by contamination level.
依污染程度清潔並沖洗傷口。 - 2.Moisten dressing on battery (dot) side with saline, sterile water, or sterile amorphous water-based hydrogel. Hydrogel will not evaporate as quickly, allows dressing to remain in place for 7 days, best for incisions and open wounds (according to company insert).
用生理食鹽水、無菌水或無菌非晶態水凝膠濕潤敷料電池（圓點）面。水凝膠蒸發速度較慢，可使敷料保留 7 天，最適合用於切口和開放性傷口（根據公司說明書）。
Saline/water-excellent conductive medium but dries out more quickly and will require periodic remoistening, do not over saturate or wound maceration can occur.
生理食鹽水/水是優良的導電介質，但乾燥速度較快，需定期重新濕潤，切勿過度飽和以免造成傷口浸漬。 - 3.Place dressing battery (dot) side down on wound. Ensure contact with the wound. If the wound is deep place filler material over the dressing in the wound to hold contact, be sure to include 1–2 cm of dressing overlap of the wound edge.
將敷料電池（圓點）面朝下置於傷口上。確保與傷口接觸。若傷口較深，可在敷料上放置填充材料以保持接觸，並確保敷料邊緣超出傷口邊緣 1-2 公分。 - 4.Cover with secondary dressing. If wound is mildly exudative a semiocclusive dressing can be placed (Tegaderm, Opsite, and so forth). If wound is highly exudative place absorptive layer (hydrocolloid foam, gauze, lap sponges, and so forth) as a secondary dressing.
覆蓋第二層敷料。若傷口滲出液較少，可使用半閉合性敷料（如 Tegaderm、Opsite 等）。若傷口滲出液較多，則應使用吸收層（如水膠體泡沫、紗布、腹腔手術海綿等）作為第二層敷料。 - 5.Dressing change frequency is determined by the amount of wound exudate produced. The dressing can remain in place for up to 7 days if low-exudative wound. If the wound is highly exudative, dressings can be changed 2–3× a week.
敷料更換頻率取決於傷口滲出液的量。若為低滲出性傷口，敷料可保留長達 7 天。若傷口滲出液較多，則每週需更換敷料 2-3 次。 - 6.To remove the bioelectric dressing if it is adhered to the wound moistens the dressing with sterile saline or water until it can be gently peeled away.
若要移除黏附於傷口的生物電敷料，需先用無菌生理食鹽水或清水浸濕敷料，直至可輕柔地將其剝離。
With the data from experimental and anecdotal case series, bioelectric dressings seem a promising new tool in the treatment of veterinary wound but controlled clinical trials should be performed to determine the best timing (phase of healing) and methodology (dressing change frequency) for their use.
根據實驗性及個案系列報告的數據顯示，生物電敷料在獸醫傷口治療中似乎是種極具前景的新工具，但仍需進行對照臨床試驗以確定其最佳使用時機（癒合階段）與方法（敷料更換頻率）。
根據實驗性及個案系列報告的數據顯示，生物電敷料在獸醫傷口治療中似乎是種極具前景的新工具，但仍需進行對照臨床試驗以確定其最佳使用時機（癒合階段）與方法（敷料更換頻率）。
Clinics care points 臨床照護要點
- •NPWT is best applied during the inflammatory and debridement phases of healing or to bolster closed at-risk incisions. This therapy can be applied with and without foam/dressings and with the use of commercial or common surgical suction devices.
負壓傷口治療（NPWT）最適合應用於傷口癒合的發炎期與清創期，或用以加強保護高風險縫合切口。此療法可搭配或無需使用泡棉敷料，並能採用商業化或一般外科抽吸裝置進行。 - •The use of fish skin grafts has been successfully used on veterinary patients for the treatment of large wounds, but an easily accessible preparation method of the fish skin grafts has yet to be published and risks associated with possible infection need to be considered.
魚皮移植已成功應用於獸醫患者治療大面積傷口，但尚未發表易於取得的魚皮移植製備方法，且需考慮可能感染相關風險。 - •Platelet-rich plasma is a noninvasive treatment option for cutaneous wounds with mixed results. PRP can be injected subcutaneously or used topically and is easier to produce than stem cell therapies with commercially available kits and devices.
富含血小板血漿是一種非侵入性的皮膚傷口治療選擇，其效果好壞參半。PRP 可通過皮下注射或局部使用，且相較於幹細胞療法，利用市售套組與設備更易於製備。 - •Bioelectric dressings recreate the normal transepithelial potential to induce epithelialization and decrease bacterial contamination. These dressings need to be moistened before application to the wound but can be applied for 4 to 5 days at a time, decreasing the need for bandage changes during the repair phase.
生物電敷料能重建正常的上皮跨膜電位，誘導上皮化並減少細菌污染。這類敷料在使用前需先潤濕，但每次可敷用 4 至 5 天，減少修復階段更換繃帶的需求。
Disclosure 利益揭露聲明
The author has nothing to disclose.
作者無需揭露任何利益關係。
作者無需揭露任何利益關係。
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